Abstract Background Isolated hepatitis B core antibody (anti‐HBc pos, anti‐HBs neg, HBsAg neg) serology is frequently observed in people living with HIV. It typically indicates a resolved hepatitis B virus (HBV) infection but may also reflect occult HBV infection, with a potential risk of reactivation. Tenofovir (TFV) containing antiretroviral therapy (ART) effectively suppresses HBV replication; however, TFV‐sparing dual regimens are increasingly used. This study evaluates evidence of HBV reactivation in people living with HIV with isolated anti‐HBc patterns receiving TFV‐sparing dual ART. Methods We conducted a single‐centre cross‐sectional study. All people living with HIV receiving TFV‐sparing dual ART with a documented prior isolated anti‐HBc serological pattern who attended routine clinical visits between April 2024 and March 2025 were invited to participate. HBV serologies and HBV DNA were performed at the study visit. Reactivation was considered as the presence of HBV‐DNA or HBsAg. Results Among the 4006 people living with HIV in our cohort, 1499 (37.4%) had serological evidence of prior HBV exposure and 386 had a history of isolated anti‐HBc serology. The isolated anti‐HBc pattern was confirmed in 77 participants receiving TFV‐sparing regimens: 57 on dolutegravir (DTG) plus lamivudine (3TC), 13 on DTG plus rilpivirine and 7 on long‐acting cabotegravir plus rilpivirine. Median age was 60 years (interquartile range IQR 57–62), 83% were male, 84% had prior hepatitis C virus (HCV) coinfection, and the median time on the TFV‐sparing regimen was 3.36 years (IQR 2.79–3.93). Among the 20 participants receiving regimens without any HBV‐active drugs (no TFV or 3TC), no evidence of HBV reactivation was detected. One participant receiving DTG plus 3TC showed a transient, unconfirmed HBV DNA blip (29 IU/mL), not associated with transaminase increase. Conclusions In this cross‐sectional assessment, no evidence of HBV reactivation was detected in people living with HIV with isolated anti‐HBc receiving TFV‐sparing dual ART, including regimens without direct anti‐HBV activity.
Arcos‐Rueda et al. (2026) studied this question.