Background: Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) co-infection in South Africa is estimated between 5-17%; however research determining this prevalence is lacking. With co-infection there is increased risk of liver cirrhosis, end stage liver disease, death as well as higher rates of chronic Hepatitis B infection. Chronic HBV develops in 20% of HIV positive individuals when compared to less than 5% in HIV negative individuals. This also further complicates Highly Active AntiRetroviral Treatment (HAART). Methods: A retrospective observational quantitative, cross-sectional, analytical study was done at the TC Newman Antiretroviral (ARV) centre in Paarl. All adult HIV positive patients that were started on antiretroviral therapy for the time period the new protocol was implemented were analyzed according to their Hepatitis B Antigen (HBsAg) result as well as for any association with gender, CD4 and age. The new protocol stated that all patients who were to start ARV’s had to be tested for Hepatitis B by testing their HBsAg. Results: A total of 498 participants were identified of which 40% were male and 60% were female. The HBsAg positivity rate was established at 7.6%. A higher prevalence was found among men as well as in the age group 50-59 years and those with a CD4 of 50/μL and less. Conclusions: With a prevalence of almost 8% there should definitely be a recommendation towards routine testing of HIV positive patients for Hepatitis B. If not before commencing ART then at least when switching from a regimen containing Lamivudine (3TC) or Tenofovir (TDF) to a regimen not containing these drugs in order to prevent acute flare ups of hepatitis.