Hepatitis B core antibody positivity is not associated with risk of transaminase elevation following switch to dual antiretroviral therapy.

OBJECTIVE

To evaluate whether hepatitis B core antibodies, indicative of possible occult hepatitis B virus (HBV) infection (pOBI), are associated with an increased risk of transaminase elevation in people with HIV (PWH) switching to two-drug regimens (2DR).

DESIGN

Cohort study.

METHODS

We included PWH who switched to 2DR since 2018, if they discontinued at least one anti-HBV drug and were HBsAg-negative at baseline. Two cohorts were analyzed: cohort 1 discontinued tenofovir (TFV) but continued lamivudine (3TC), Cohort 2 switched to regimens without HBV-active drugs. Survival analysis, including Cox regression adjusting for potential confounders, was conducted to compare time to grade ≥1 transaminase increase in those with and without pOBI.

RESULTS

Among 167 patients in cohort 1 (35.2% with pOBI), the rate of transaminitis was 4.59 vs. 7.47 per 100 person-years for those with and without pOBI [incidence rate ratio (IRR) 0.61; 95% confidence interval (CI) 0.17-1.83; P  = 0.259]. Cox multivariable analysis found no significant association between pOBI and transaminitis (hazard ratio 0.56; 95% CI 0.2-1.5; P  = 0.266), with adjusted models confirming these results. Among 118 individuals in cohort 2 (33.9% with pOBI), transaminitis rates were 8.04 vs. 8.68 per 100 person-years for those with and without pOBI (IRR 0.93; 95% CI 0.19-3.91; P  = 0.763). Cox regression showed no significant association between pOBI and transaminitis (hazard ratio 1.18; 95% CI 0.4-3.6; P  = 0.769), with consistent findings in adjusted models. No HBV reactivation occurred in either cohort.

CONCLUSION

pOBI was not associated with risk of transaminase elevation in PWH switching to dual therapies lacking anti-HBV agents.