Use of dual antiretroviral therapy in individuals with different serological patterns for hepatitis B: What are the risks? What are the clinical implications?

作者：Arda Kaya, Dominik Benke, Tracy Swan, Sven Breitschwerdt, Jan‐Christian Wasmuth, Christoph Boesecke, Jürgen K. Rockstroh · 发表于：HIV Medicine · 年份：2025 · DOI：10.1111/hiv.70063 · 被引用次数：6 · 研究领域：Hepatitis B Virus Studies、Hepatitis C virus research、HIV/AIDS Research and Interventions

With the introduction of the first registered long-acting two-drug antiretroviral therapy cabotegravir/rilpivirine (CAB/RPV-LA), a growing number of people living with HIV have been switched over to this new treatment option, often upon patient request, to help overcome HIV stigma and pill fatigue. Transitioning off a mostly tenofovir-based treatment, however, comes at the risk of hepatitis B virus (HBV) infection or reactivation. Besides CAB/RPV-LA, there has been increasing interest in two-drug regimens (2DR) without anti-HBV activity, including daily, oral weekly, or long-acting injectable therapies. In view of these trends, we discuss potential risks and clinical implications here (key messages summarized in Table 1). Due to shared transmission routes, HBV/HIV coinfection is common. The European AIDS Clinical Society (EACS) guidelines recommend tenofovir-containing antiretroviral therapy (ART) for people with HBV/HIV coinfection. Tenofovir (given as one of the available prodrugs TDF or TAF) not only treats existing hepatitis B, but also protects against acquiring HBV infection [3, 4]. The protective effect has also been shown for men who have sex with men under daily HIV pre-exposure prophylaxis [5]. Lamivudine has also been shown to offer some protection against incident HBV infection, albeit to a lesser extent [3, 4]. Ongoing risk behaviour, lack of implementation of EACS vaccination recommendations [6] and insufficient response to HBV vaccines due to HIV-associated imm...