Preventing HBV Infection with ART

Summary and Comment |
May 24, 2013

Preventing HBV Infection with ART

  1. Helmut Albrecht, MD

Antiretroviral regimens containing 3TC, tenofovir, or both, reduced the risk for incident hepatitis B virus infection by approximately 90% compared with other or no antiretrovirals.

  1. Helmut Albrecht, MD

Hepatitis B virus (HBV) coinfection is common in HIV-infected individuals, particularly men who have sex with men (MSM). Tenofovir, 3TC, and FTC have clinically relevant anti-HBV activity, which has been demonstrated in prospective trials. Whether these agents might prevent incident HBV infection has not been examined previously.

To explore this issue, researchers in Japan evaluated sequential samples from HIV-infected MSM who had serum stored between April 1997 and December 2009 and had no detectable HBV surface antigen or antibodies to HBV surface or core proteins at baseline. Evidence of HBV infection was detected in follow-up samples from 43 of the 354 men (12.1%) after a median of 1.6 years (range, 28–4068 days). The rate of incident infection was approximately 90% lower for patients taking 3TC or tenofovir than for those receiving no ART or a non–3TC/tenofovir-containing regimen. No new infections occurred while patients were taking tenofovir. The 7 men who developed HBV infection while on 3TC were more likely to be infected with 3TC-resistant strains than were the 36 individuals who did so while taking other regimens or no ART (50% vs. 7%)


At first look, these results may not seem particularly surprising. However, the fact that this study provides a risk estimate for the effectiveness of antiretroviral medications in preventing incident HBV infection is important. Many scenarios exist in which protection against HBV would be desirable, but time is insufficient to vaccinate exposed or at-risk individuals. We do not know whether the present results will directly translate to other populations, including MSM in the U.S., HBV-serodiscordant heterosexual couples, HIV-uninfected populations, pregnant women, and people requiring postexposure prophylaxis, but the study at least suggests the feasibility of HBV preexposure prophylaxis (PREP) with antiretrovirals.

Nonetheless, HBV PREP with antiretrovirals is not the perfect answer. Selection for drug-resistant strains, as seen here, is an obvious drawback. Furthermore, the drugs used were not uniformly effective, as evidenced by the breakthrough infections on 3TC. The authors, however, may have underestimated the true effectiveness of antiretroviral drugs: Few patients were on the current standard combination regimen of tenofovir/FTC, which should provide double protection against HBV. All of this would prove academic if we could improve HBV vaccine coverage in at-risk patients.


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