Clinically Relevant Risk of Hepatitis B Virus Infection and Reactivation in People with HIV After Withdrawal of Anti-HBV–Active Antiretroviral Therapy in Japan

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ID: 325424
2026
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Abstract
Abstract Background In people with HIV (PWH), antiretroviral therapy (ART) containing anti-HBV drugs provides protection against hepatitis B virus (HBV) infection. However, the risk of HBV infection or reactivation after switching to ART without anti-HBV activity remains unclear, particularly in settings with recent implementation of universal HBV vaccination. Methods We conducted a single-center retrospective cohort study of PWH who received ART regimens without anti-HBV activity between January 2005 and March 2026. HBV serological status at baseline was classified, and participants were followed during periods on ART without tenofovir, lamivudine, or emtricitabine. Incident HBV infection and HBV reactivation were defined based on serological and virological criteria. Results A total of 166 PWH were included, with 716 person-years (PY) of follow-up. Five HBV-related events were observed. Two occurred in HBV-naïve individuals and were consistent with incident HBV infection based on seroconversion to anti-HBc and anti-HBs positivity. Two cases with isolated anti-HBc positivity were classified as suspected HBV reactivation based on marked increases in anti-HBs titers. The remaining case with isolated anti-HBc positivity was confirmed HBV reactivation. The overall incidence rate was 0.70 per 100 PY, increasing to 1.28 per 100 PY in anti-HBs–negative individuals. Kaplan–Meier analysis showed lower event-free survival in anti-HBs–negative individuals compared with those with anti-HBs positivity. (log-rank p = 0.0084). Conclusions In PWH receiving ART without anti-HBV activity, the risk of HBV infection and reactivation becomes apparent, particularly among those without anti-HBs, especially those with isolated anti-HBc, in settings with limited impact of universal HBV vaccination.
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Authors Eisuke Adachi, Aiko Okazaki, Yoshiaki Kanno, Michiko Koga, Hiroshi Yotsuyanagi
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag533
URL
https://doi.org/10.1093/ofid/ofag533
Keywords Keywords not found

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