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. 2026 Feb 9;82(1):e176-e184.
doi: 10.1093/cid/ciaf281.

Kinetics and Predictors of Hepatitis B Surface Antigen Loss After Commencing Hepatitis B Virus (HBV)-Active Antiretroviral Therapy in the Setting of HIV and Chronic HBV Coinfection

Jennifer Audsley  1 , Anchalee Avihingsanon  2 , Xin Li  3 , Rosalind Edwards  3 , Kathy Jackson  3 , Nadia Warner  3 , Olivia Maslac  3 , Peter A Revill  1   3 , Hay Mar Su Lwin  2 , Sivaporn Gatechompol  2 , Nagalingeswaran Kumarasamy  4 , Tim Spelman  5   6   7 , Iskandar Azwa  8 , Adeeba Kamarulzaman  8 , Sharon R Lewin  1   9   10 , Joe Sasadeusz  1   9   10
Affiliations

Kinetics and Predictors of Hepatitis B Surface Antigen Loss After Commencing Hepatitis B Virus (HBV)-Active Antiretroviral Therapy in the Setting of HIV and Chronic HBV Coinfection

Jennifer Audsley et al. Clin Infect Dis. .

Abstract

Background: An effective therapeutic strategy for hepatis B virus (HBV) cure remains an urgent unmet need. We aimed to define the incidence, kinetics, and predictors of hepatitis B surface antigen (HBsAg) loss in people with HIV and HBV (PWH-HBV) following HBV-active antiretroviral therapy (ART) in PWH-HBV in Asia.

Methods: 97 PWH-HBV commencing HBV-active ART were recruited prospectively in Thailand (n = 94) and Malaysia (n = 3), then followed for 24 months. Time to HBV serology change was calculated. Univariate associations between baseline characteristics and HBsAg loss were examined using the Mann-Whitney or chi-square tests. Multivariable analysis was undertaken using Cox regression.

Results: Twenty-one individuals (22%) lost HBsAg during follow-up (11.7 per 100 person-years), 14 of whom gained anti-HBs. Twenty-two of 61 (36.1%) individuals who were hepatitis B "e" antigen (HBeAg) positive at baseline lost HBeAg over the study, 15 of whom gained anti-HBe. Most individuals lost HBsAg and HBeAg by the month 12 study visit (81% and 63.6%, respectively), with median times of 5.8 and 12.0 months to HBsAg and HBeAg loss, respectively. Univariate analysis showed baseline characteristics associated with HBsAg loss were higher alanine aminotransferase (ALT; P = .005), tenofovir alafenamide (TAF)-containing ART regimen (P = .025), younger age (P = .040), lower liver stiffness (P = .010), and quantitative HBsAg < log10 2.0 IU/mL (P = .001). All 5 factors remained significant in a Cox regression analysis that adjusted for baseline CD4 count.

Conclusions: High HBsAg loss rates occur in PWH and HBV early after commencing ART. Our study suggests that TAF-containing ART regimens may be preferable as first-line therapy in HIV-HBV coinfection.

Keywords: HBsAg loss; HIV-HBV coinfection; antiretroviral therapy; tenofovir alafenamide; treatment initiation.

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Conflict of interest statement

Potential conflicts of interest. S. R.L . receives research support from the National Health and Medical Research Council of Australia (NHMRC) and the Victorian Government Department of Health and the National Institutes of Health. She has received consultancy fees from Abivax, Geovax, ViiV, Tetralogic, Vaxxinity, and Esfam and honoraria from Gilead Sciences and Merck. A. A. has participated in a Speaker's Bureau sponsored by Jensen-Cilag. All other authors report no potential conflicts.

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