Hepatitis B virus functional cure in persons with HIV: what are the predictors and which novel markers are useful?

For individuals with hepatitis B virus (HBV), hepatitis B surface antigen (HBsAg) loss is associated with substantially decreased risk of liver-related morbidity and mortality. In recent years, many determinants of HBsAg loss have been investigated in several studies involving persons with chronic HBV infection living with and without HIV. The purpose of this review is to summarize factors that could help predict HBsAg loss in persons with HIV (PWH).

Rates of HBsAg loss can be higher in PWH with HBV compared to those without HIV, which has been partially attributed to immune reconstitution after starting antiretroviral therapy. In recent years, quantitative HBsAg (qHBsAg) levels were identified as the most important single serum marker predicting HBsAg loss. Other viral markers, such as hepatitis B core-related antigen, circulating HBV RNA, and immunological markers (i.e., quantitative hepatitis B core antibody, assessment of HBV-specific immune responses, peripheral blood mononuclear cells phenotypes), might also help predict HBsAg loss in PWH with HBV, particularly for certain sub-populations.

Low qHBsAg before or fast qHBsAg declines after initiating potent anti-HBV therapy has been identified as the most reliable predicting serum marker. Other markers might be useful in certain sub-populations and clinical situations.