Present in the bloodHepatitis B virus (HBV).Evidence of core antibodies is a long-term sign of previous infection.
In the US, approximately 4% of people living with HIV are positive for HBV core antibodies (CAB+); Worldwide, the percentage is much higher, approximately
The isolated CAB+ is a limbic state in which there is usually no evidence of virus in the blood and no surface antibodies associated with preventing reactivation. In this case, most people do not experience reactivation of HBV, but they can, especially when immunosuppressed.
There is not much concern about positive HBV core antibodies in HIV-infected patients receiving tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) as well as emtricitabine (FTC) or lamivudine (3TC)*because these combinations of antibodies are very effective against HBV. However, with the advent of dual HIV** regimens that do not contain HBV-active drugs, it is possible to reactivate HBV after switching.
To quantify this, researchers from the Department of Veterans Affairs reported at IDWEEK 2023 that data from 60,290 people living with HIV were examined in the Veterans Aging Cohort Study (VACS), of which 20,941 were CAB+. Of these CAB+ patients, 5,954 switched to antiretrovirals without tenofovir, 3TC, or FTC** and were at risk of HBV reactivation due to HBV surface antigen negativity (otherwise they would have been active HBV cases) and undetectable HBV DNA (if examined).
Use a new surface antigen positive or a new HBV DNA test result converted from the HBV activity regimenOf the 5,954 patients, 89 (1.)5%) experienced HBV reactivation.
It may seem more than trivial; However, the investigators continued to exclude those patients who had HBV reactivation after restarting HBV-active HIV** or stopping antiretroviral drugs altogether, reaching 39 (0.).7%）。The median time to reactivation was 292 days。Those who have ever had a surface antigen test appear to be at greater risk.
Bottom line: Consider the potential for HBV when simplifying HIV** protocols
This retrospective analysis highlights an important risk that is of little concern to HIV clinicians in the United States. Because HBV is not common among people living with HIV in the United States, it is often forgotten if it is not visible. However, this is the luxury that the "two birds with one stone" antiretroviral drugs we use for both viruses provides. We found no HBV by combinations such as cabotegravir (CAB) and rilpivirine (RPV), dolutegravir (DTG) and RPV, and possibly even DTG and 3TC.
This study showed that the risk of reactivation was low, but not zero, for isolated CAB+ patients。Moreover, in these cases, it was not exactly a mild reactivation. Most patients have elevated ALT levels above 100 mg DL, and 40% are hospitalized within 30 days of HBV reactivation. Even if the risk is 1 in 100, the risk of HBV** should be included in the discussion of the simplified** regimen for CAB+ patients.
end.**Youai Classroom.