Hepatitis B Reactivation and Infection in People with HIV on Tenofovir-Sparing Antiretroviral Therapy

Background As more people with HIV (PWH) transition to tenofovir (TXF)-sparing antiretroviral therapy (ART), the risk of hepatitis B virus (HBV) reactivation (HBVr) and new infection (HBVi) is a concern. Methods We conducted a retrospective study of 5,776 PWH in the Centers for AIDS Research Network of Integrated Clinical Systems cohort without active HBV infection with ≥1 TXF-sparing ART regimen prescribed after 5/1/2014 and examined episodes of HBVi/r defined as new HBV surface antigen (HBsAg) positivity or HBV viremia. We calculated rate of HBVi/r over total time on TXF-sparing ART per 10,000 person-years. Results We identified 17 cases of HBVi/r over a median 5.3 years of follow up. The rate of HBVi was 3.9 per 10,000 person-years, and rate of HBVr was 6.0 per 10,000 person-years, with possible higher risk for those who were HBV surface antibody (HBsAb) negative at cohort entry and among those not on ART with no anti-HBV activity. Liver injury, defined as alanine aminotransferase lab value ≥ 100 U/L, occurred within 3 months in only one HBVi case. Conclusions HBVi/r on TXF-sparing ART was rare in this U.S. cohort. HBVi/r occurred in some with prior HBsAb positivity, but significant hepatic flares were not observed. When starting TXF-sparing ART, providers should check complete HBV serologies, offer initial or additional vaccination as needed, and monitor for potential HBVi/r.