Use of dual ART in individuals with different HBV serological patterns

Area of Science:

• Infectious Diseases
• Hepatology
• Antiretroviral Therapy

Background:

• Two-drug regimens (2DR) are increasingly recommended for HIV treatment to minimize pill burden and toxicity.
• The exclusion of tenofovir and lamivudine/emtricitabine in 2DRs raises concerns about hepatitis B virus (HBV) acquisition and reactivation.

Purpose of the Study:

• To review the implications of 2DRs on HBV acquisition and reactivation in people with HIV.
• To assess the risk of HBV reactivation associated with different 2DR formulations.

Main Methods:

• Systematic review of case-series, cohort studies, and randomized-controlled trials evaluating HBV outcomes in patients on 2DRs.
• Analysis of HBV reactivation (HBVr) risk based on specific drug combinations and prior HBV exposure (HBsAg positivity).

Main Results:

• The risk of HBVr is negligible when switching to 2DRs containing lamivudine.
• The overall risk of HBVr is low (~1%) for patients switching to tenofovir and lamivudine/emtricitabine-free therapy.
• Even remote HBsAg positivity significantly increases the risk of HBVr.

Conclusions:

• Pre-switch HBV serological assessment is crucial for people with HIV initiating 2DRs.
• Vaccination against HBV is recommended for individuals without prior exposure or HBsAb.
• Careful monitoring and patient counseling are advised, particularly regarding the low risk of HBVr with lamivudine-containing 2DRs.