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

Year: 2026
Type: article
Study design: Observational Study
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.
DOI: 10.1093/ofid/ofag731
Authors: G C Haser, N E Lisha, H N Kim, G Burkholder, E R Cachay, H M Crane, J A C Delaney, O Falade-Nwulia, J Fleming, M M Kitahata, A C Pettit, S E Rutstein, G Yendewa, A F Luetkemeyer, K A Christopoulos
Institutions: University of California, San Francisco, University of Washington, University of Alabama at Birmingham, University of California San Diego, Johns Hopkins University, Fenway Health, Vanderbilt University Medical Center, University of North Carolina at Chapel Hill, Case Western Reserve University
Language: English
Subfield: Epidemiology
Field: Medicine
Open Access status: gold
Estimated APC paid: $4,053
Funders: Gilead Sciences, Vanderbilt University, University of Miami, University of Washington, Johns Hopkins University, Case Western Reserve University, National Institutes of Health, University of California, San Francisco, National Institute of Allergy and Infectious Diseases
Awards: G2122320390, G2483435703, G3040019378, G3138949240, G3181090803, G4575219416, G4610217253, G5641387088, G6625095162, G7364671334, G7791962275, G7871313406, Training in HIV Translational Research
OpenAlex ID: W7225448922
FWCI:
Cites: 4
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Related to: 10