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

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ID: 339203
2026
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Abstract
Abstract 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.
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Authors Grace C. Haser, N E Lisha, H. Nina Kim, G Burkholder, E.R Cachay, H M Crane, J A C Delaney, Oluwaseun O Falade-Nwulia, J Fleming, Mari M. Kitahata, A C Pettit, Sarah E. Rutstein, G Yendewa, Annie F. Luetkemeyer, K. A. Christopoulos
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag731
URL
https://doi.org/10.1093/ofid/ofag731
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