A cohort study examining the risk of hepatitis B virus (HBV) reactivation in people with HIV who switch to antiretrovirals (ARV) that don't provide dual protection found that the overall risk is low, even among those with a positive hepatitis B core antibody.
The results were presented by Rachel V. Denyer, MD, MRCP, of the Washington DC VA Medical Center and George Washington University, during a session at IDWeek 2023, taking place October 11-14, in Boston, Massachusetts.
New ARVs introduced in the last 10 years, including dolutegravir-rilpivirine and long-acting injectable cabotegravir-rilpivirine, are becoming a preferred treatment for people with HIV, however; this discontinuation of drugs like tenofovir that include nucleos(t)ide reverse transcriptase inhibitors (NRTIs) that have dual activity against both HIV and HBV put individuals at risk of HBV reactivation.
To better understand this risk, Denyer and colleagues used data from 60,290 people with HIV enrolled in the Veterans Aging Cohort Study to identify HBV reactivation in cAb-positive people with HIV who switched from ARV with HBV activity (AHB+) to regimens without HBV activity (AHB-).
Key Takeaways
- Low Risk of HBV Reactivation: HBV reactivation in people with HIV who switched to ARVs lacking dual protection against both HIV and HBV is generally low, even among those with a positive hepatitis B core antibody.
- Subgroup Differences: People with a positive hepatitis B surface antibody had a lower risk of reactivation in some cases.
- Patient-Provider Counseling: It's important that providers discuss HBV reactivation risk when considering switching ARV regimens. It's also advised that hepatitis serology results be reviewed prior to the switch.
Overall, 7,860 individuals were identified who switched to AHB- regimens prior to December 31, 2022, and had prior positive cAb but negative hepatitis B surface antigen (sAg) prior to the switch. People with HIV with active HBV infection (positive sAg or detectable hepatitis B DNA before switching) were excluded, leaving 7,081 participants for analysis. The study also included people with HIV with a history of remote positive sAg who did not meet the criteria for active HBV infection. HBV reactivation was defined as the detection of hepatitis B DNA or sAg. The AHB+ regimens included lamivudine, emtricitabine, and/or tenofovir.
Among people with HIV with positive cAb (n=115) who switched to AHB- regimens, HBV reactivation occurred in 1.6% of cases. Subgroup analyses revealed significant differences in reactivation risk between individuals with no prior positive sAg and those with a history of remote positive sAg (1.0% vs. 20.2%, P <.0001). Among people with HIV with no prior positive sAg, those with a positive hepatitis B surface antibody (sAb) had a lower risk of HBV reactivation (0.4%) compared to those without positive sAb (1.1%), though the difference was not statistically significant (P = .065). In cases with remote prior positive sAg, no difference in reactivation risk was observed based on sAb status (P = .64).
Overall, the risk of HBV reactivation following a switch from AHB+ to AHB- regimens in people with HIV who are cAb-positive without prior positive sAg is low. Still, the study underscores the importance of patient-provider discussion of HBV reactivation risk when considering switching ARV regimens. Additionally, the investigators noted that providers should be conducting a "pre-switch review of all prior hepatitis serology results" to further characterize HBV status in patients with HIV.
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REFERENCE
Denyer RV, Tate JP, Benator DA, Lim JK, Weintrob A. Hepatitis B Reactivation in Persons with HIV with Positive Hepatitis B Core Antibody after Switching to Antiretroviral Therapy without Hepatitis B Activity. Presented at: IDWeek 2023. October 11-14, 2023; Boston, MA. Abstract 1026.
