Hepatitis B Viral Rebound in People With HIV Under HBV‐Active Antiretroviral Therapy

We investigated factors associated with HBV‐rebound in people with HIV (PWH) with chronic HBV (CHBV) under HBV‐active antiretroviral therapy (ART): emtricitabine (FTC)+tenofovir alafenamide (TAF) or 3TC/FTC+ tenofovir disoproxil fumarate (TDF) regimen. The present study included PWH/CHBV followed as outpatients from October 2008 to August 2023 at San Raffaele Hospital, Milan, Italy. The baseline evaluation was the date of first negative HBV‐DNA (< 10 IU/mL) after the first positive result before HBV active ART. Last evaluation (LE) was the first HBV‐rebound (≥ 10 IU/mL) or last HBV undetectable in persistently HBV‐DNA negative PWH. Odds ratio (and corresponding 95% confidence interval) of HBV‐rebound, adjusted for nadir CD4 cells, ALT levels, and ART active on both viruses was estimated by multivariable logistic regression. Of 153 PWH/CHBV under ART active on both viruses, 25 (16.3%) had at least one HBV‐rebound. Multivariate analysis at LE, showed that PWH on 3TC/FTC had a higher probability of HBV‐rebound [adjusted odds ratio, aOR=4.88 (95%confidence interval, CI = 1.28, 20.10), p = 0.02], while PWH on FTC + TAF had lower probability of HBV‐rebound [aOR = 0.05 (95%CI = 0.002, 0.27), p = 0.005], both compared to those on 3TC/FCT + TDF. Hepatitis B‐rebound was associated with higher ALT levels [aOR=1.03 (95% CI = 1.01, 1.05) per 1‐U/L higher, p = 0.001]. FTC + TAF based ART seemed to be related to a better control of HBV‐DNA than 3TC/FTC + TDF and 3TC/FTC alone. Hepatitis B‐rebound may exert an effect on liver inflammation, as suggested by the increase of transaminases levels.