Don’t Drop the B: Risk of Hepatitis B Virus Infection and Reactivation in the Era of Tenofovir-Sparing Regimens for Treatment and Prevention of HIV

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ID: 315085
2026
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Ranked #421 of 545 articles by views in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Abstract
Tenofovir-sparing antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) are increasingly used. However, these regimens may increase the risk of new hepatitis B virus (HBV) infection or reactivation due to lack of full activity against HBV. The magnitude and mechanism of risk can vary by baseline HBV serologic profile and need to be discussed with the patient before switching regimens. Importantly, these risks can be mitigated through HBV screening, vaccination, and post-switch monitoring. Here, we synthesize the evidence across different clinical scenarios and propose a practical workflow to reduce the potential but preventable risk during transitions to tenofovir-sparing regimens. Finally, we highlight knowledge gaps and outline future research priorities. The decision to switch to tenofovir-sparing ART or PrEP should not be made solely through the lens of HIV efficacy and convenience and must incorporate HBV prevention and reactivation risk.
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openalex_W7162484119 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Tzu-Hao Lee, Debika Bhattacharya, H Nina Kim
Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2026
DOI
10.1093/cid/ciag322
URL
https://doi.org/10.1093/cid/ciag322
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