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. 2024 Feb 23;16(3):348.
doi: 10.3390/v16030348.

HBcAb Positivity as a Risk Factor for Missing HIV RNA Undetectability after the 3TC+DTG Switch

Vincenzo Malagnino  1   2 , Tiziana Mulas  1 , Elisabetta Teti  1 , Monica Basso  3 , Mario Giobbia  4 , Nicholas Geremia  5 , Giuliana Battagin  6 , Yasmine Abi Aad  7 , Jean-Paul Vincensini  7 , Marco Iannetta  1   2 , Saverio Giuseppe Parisi  3 , Loredana Sarmati  1   2 , Karine Lacombe  7   8
Affiliations

HBcAb Positivity as a Risk Factor for Missing HIV RNA Undetectability after the 3TC+DTG Switch

Vincenzo Malagnino et al. Viruses. .

Abstract

Hepatitis B Core antibody (HBcAb) positivity is the surrogate marker of hepatitis B occult infection. This condition is not a contraindication for switching to two-drug (2DR) antiretroviral therapy; however, the removal of tenofovir may contribute to poor control of HBV replication. A multicentre retrospective cohort study investigated the impact of HBcAb positivity on HIV control in patients switching to a 2DR with Lamivudine and Dolutegravir (3TC-DTG). In this study, a comparison analysis was conducted between HBcAb-positive and -negative PLWH regarding HIV-RNA suppression, considering: (1): Target Not Detected (TND) < 20 cp/mL; (2) Target Detected (TD) < 20 cp/mL; and (3) Detectable > 20 cp/mL and <50 cp/mL and >50 copies/mL. A total of 267 patients on 2DR with 3TC-DTG were included. In comparison to HBcAb-negative, HBcAb-positive patients were older (45 years [35-54]) and had a lower CD4+ nadir (248 vs. 349 cells/mmc, p = 0.007). No difference in the maintenance of virological suppression was present in the two groups of patients before the switch. Although no patient had an HIV-RNA > 20 cp/mL after the switch, significantly fewer HBcAb-positive compared with -negative subjects resulted in TND at 12, 24, and 36 months after the switch: 52 (69.3%) versus 164 (85.4%), p = 0.004, 50 [72.5%] versus 143 [89.9%], p = 0.001, and 30 [66.7%] versus 90 [92.8%], p = 0.001, respectively. HBcAb positivity is associated with an increased risk of suboptimal HIV suppression during the 36 months after 3TC/DTG simplification. This finding reinforces the relevance of the OBI condition in PLWH and raises the issue of careful virological monitoring of such cases.

Keywords: HBcAb+; HIV/HBV; OBI.

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Conflict of interest statement

The authors have no conflicts of interest to report. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1
Figure 1
Patient inclusion and exclusion algorithm.
Figure 2
Figure 2
HIV-RNA control during follow-up in the general population.
Figure 3
Figure 3
Trends in HIV-RNA control during follow-up in different subpopulations. Abbreviations: n.s.: not significance; ** p-value < 0.001; *** p-value < 0.0001.
See this image and copyright information in PMC

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