Background
Long-term tenofovir-containing antiretroviral therapy (ART) achieves durable suppression of HIV and HBV, but its effect on functional cure of HBV infeciton in people with HIV (PWH) remains unclear. We aimed to determine the incidence of and factors associated with hepatitis B surface antigen (HBsAg) loss after treatment with tenofovir-containing ART in HBV-coinfected PWH.
Methods
Between 2011 and 2023, antiviral-naïve HBV-coinfected PWH seeking HIV care at the National Taiwan University Hospital and receiving tenofovir-containing ART as their initial antiretroviral regimen were retrospectively reviewed. HBV serologic markers and plasma HBV DNA were measured annually after ART initiation. Factors associated with HBsAg seroclearance were analyzed using the Kaplan-Meier method and Cox proportional hazards models. Clinical outcomes were compared between PWH with and those without HBsAg seroclearance.
Results
A total of 161 HBV-coinfected PWH were enrolled. The median age of the included PWH was 36 years (range 31-41) and 142 (88.2%) were men who have sex with men. Sixteen (9.9%) PWH were born in the era of nationwide, universal neonatal HBV vaccination that has been implemented since July 1986. After a median of 7.8 years (range, 3.7-9.6) of follow-up, 15 (9.3%) PWH achieved HBsAg loss. Kaplan–Meier estimates showed that the cumulative incidence of HBsAg seroclearance was significantly higher in PWH born in the era of universal neonatal HBV vaccination and those with HBsAg ≤250 IU/mL (Figure). Using multivariate Cox proportional hazards models, being born in HBV vaccination era (adjusted hazard ratio [aHR] 14.756; 95% confidence interval [CI] 2.953-73.735, p=0.001) and havinr a baseline HBsAg level ≤250 IU/mL (aHR 9.027; 95% CI 2.640-30.871, p<0.001) were associated with HBsAg seroclearance after adjusting for age at enrollment, baseline CD4 count, plasma HBV DNA load, and HBeAg serostatus. None of the PWH with HBsAg seroclearance developed cirrhosis of the liver or hepatocellular carcinoma (HCC), while 7.8% and 1.4% of PWH without HBsAg seroclearance developed cirrhosis and HCC, respectively.
Conclusions
In the era of tenofovir-containing ART, HBsAg seroclearance was uncommon in HBV-coinfected PWH. The statistically significant association between neonatal HBV vaccination history and HBsAg loss suggested that PWH who acquired HBV infection through horizontal transmission route may have a higher probability for functional cure of HBV infection.