Adherence to European AIDS clinical society hepatitis B management guidelines in people with HIV: real-world evidence from Spain and Germany

Objective: To evaluate adherence to hepatitis B virus (HBV) management recommendations among people with HIV (PWH) and chronic HBV infection. Design: A multicenter cross-sectional study. Methods: We conducted a cross-sectional study in 42 centers in Spain and Germany between June 2024 and March 2025. Chronic HBV infection was defined as at least two positive hepatitis B surface antigen tests obtained more than 6 months apart. Adherence to 2023 European AIDS Clinical Society recommendations regarding anti-HBV treatment, liver enzyme monitoring, HBV-DNA testing, antihepatitis D virus (HDV) screening, and HDV-RNA confirmation was assessed. Hepatocellular carcinoma surveillance was evaluated separately and has been reported elsewhere. Results: A total of 1235 PWH with chronic HBV infection were included. The median age was 56 years, 84% were men, and 36% were born outside Europe. Overall, 88% had HIV-RNA less than 50 copies/ml, and the median CD4 + cell count was 623 cells/μl. Among participants with available HBV-DNA result, 87% had undetectable HBV-DNA. Guideline-recommended anti-HBV treatment was documented in 88% of individuals. During the previous 12 months, liver enzyme monitoring was performed in 94% and HBV-DNA testing in 71%. Overall, 81% had ever undergone anti-HDV testing and, among anti-HDV-positive individuals, 66% had undergone HDV-RNA testing. Conclusion: Although adherence to several components of HBV care was high, gaps remain in the implementation of current recommendations for PWH, particularly in HBV-DNA monitoring and HDV evaluation. Better integration of these measures into routine HIV care may improve long-term prevention of liver-related complications.