Risks and benefits of oral HIV pre-exposure prophylaxis for people with chronic hepatitis B

Abstract

Individuals with chronic hepatitis B virus (HBV) infection who are at substantial risk of HIV acquisition benefit from pre-exposure prophylaxis (PrEP) with tenofovir-based antiviral therapy. Considering that tenofovir potently inhibits HBV, providing PrEP to individuals with HBV effectively results in treatment of their HBV infection. However, some clinicians might be hesitant to initiate PrEP in people with chronic HBV due to unknown risks of HBV reactivation, hepatitis, and acute liver failure during periods of antiviral cessation. Unfortunately, these knowledge gaps affect scale up of PrEP among people with chronic HBV. Emerging data regarding the risks and benefits of antiviral cessation in people with chronic HBV suggest that PrEP can be safely initiated despite the risks of non-adherence or discontinuation. People with chronic HBV who stop PrEP should be closely monitored for HBV reactivation and hepatitis flares after antiviral cessation.

Figure:

HIV Pre-Exposure Prophylaxis (PrEP) and hepatitis B (A) Countries with some form of PrEP program as of March 2022 are in yellow. (B) Model-estimated global prevalence of hepatitis B surface antigen HBsAg (2016). Sources: www.prepwatch.org (an initiative of AVAC: Global Advocacy for HIV Prevention); Polaris Observatory Collaborators. Lancet Gastroenterol Hepatol. 2018; 3: 383–403