CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

Methods: We searched electronic databases (PubMed, Embase, 1996-2024) and conference abstracts (2021-2024) for studies and case reports describing HBV reactivation in treated people switching to tenofovir-free ART. Reactivation was defined as HBsAg and/or HBV DNA detection by routine diagnostic assays in individuals who tested HBsAg negative and anti-HBc positive pre-switch. Reactivation in the context of ART interruption was excluded. Results: We identified 7 studies and 8 case reports. Pre- and post-switch HBV investigations were variable in routine care. Studies reported 133 reactivations among 11731 switches (1.1%), with two US cohorts contributing most data; 2854/11731 allowed post-switch use of 3TC/FTC and only one reported accordingly, noting no reactivations over 144 weeks among 71 people on DTG/3TC. There were 99 reactivations among 6093 switches to HBV-inactive ART (1.6%), with proportions ranging from 1.5% to 10% across studies (Table 1). In studies and case reports, the earliest detection of HBsAg and/or HBV DNA ranged from 1 month to 14 months post-switch. Reactivations were typically less commonly with pre-switch anti-HBs ≥10 IU/L (range 0-11%) compared with lack or loss of anti-HBs (3.2-14%). Reactivations occurred across a wide range of CD4 counts and HIV viral loads. The risk was higher with HIV viremia, lower CD4 counts, nadir CD4 counts <100 cells/mm 3 , and HBV DNA detection by ultrasensitive PCR pre-switch. Reactivations were variably associated with ALT increases. Acute hepatic flares typically resolved after re-introduction of HBV active agents, with HBsAg and/or HBV DNA loss documented within 2-5 months. Conclusions: Moderate-to-low quality evidence indicates that HBV-inactive ART carries a low but notable risk of HBV reactivation in people with a past HBV infection. Risk factors include lack or loss of anti-HBs, low current or nadir CD4 counts and detectable HBV DNA pre-switch, while detection of HBsAg and/or HBV DNA post-switch signals a heightened risk of hepatic flares. Standardization of pre- and post-switch HBV monitoring practices remains a critical need.

virological and clinical characteristics during follow-up, including virological relapse (HBV DNA >2000 IU/mL) and aminotransferase elevation (ALT >2x upper limit of normal). We determined factors associated with these clinical endpoints during the follow-up without tenofovir using univariable logistic regression with generalized estimating equations. Results: Among 192 participants, 161 (83.9%) were on continuous tenofovir, 22 (11.5%) discontinued tenofovir, and 9 (4.7%) never initiated tenofovir during a median follow-up of 14.5 years (IQR=10.5-14.8). The median proportion of within-participant visits with undetectable HBV DNA was 96.0% (IQR=75.0 100) in the continuous group (while on tenofovir), 100% (IQR=84.0-100) in the discontinued tenofovir group (while off tenofovir), and 100% (IQR=95.2-100) in the never initiated tenofovir group. Determinants of HBV DNA >2000 IU/ mL among people off tenofovir were detectable HIV RNA (p=0.041), lower CD4+ T-cell count (p=0.027), HBeAg-positive serology (p=0.004) and positive anti-hepatitis D antibody (p=0.001). ALT elevation was associated with positive anti-hepatitis C antibody (p=0.012). HBV surface antigen loss occurred in 5 of 22 (23%) participants who discontinued tenofovir and 5 of 9 (56%) participants who never initiated tenofovir. Conclusions: This proof-of-concept study shows that select people with HIV-HBV coinfection may not necessarily lose virological control of HBV when off tenofovir, and some of them achieve HBV surface antigen loss. HBV virological activity while off tenofovir may be associated with uncontrolled HIV infection and positive HBeAg serology.

Poster Abstracts

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Outcomes in HIV-Hepatitis B Coinfection Without Tenofovir-Containing Antiretroviral Therapy Amir Mohareb 1 , Patrick Miailhes 2 , Julie Bottero 3 , Caroline Lascoux-Combe 4 , Julie Chas 5 , Sarah Maylin 6 , Audrey Gabassi 7 , Hayette Rougier 8 , Emily Hyle 1 , Constance Delaugerre 4 , Karine Lacombe 9 , Anders Boyd 10 1 Massachusetts General Hospital, Boston, MA, USA, 2 Hôpital de Fleyriat, Bourg-en-Bresse, France, 3 Etablissement Public National de Santé de Fresnes, Fresnes, France, 4 Hôpital Saint-Louis, Paris, France, 5 Hôpital Tenon, Paris, France, 6 Assistance Publique – Hôpitaux de Paris, Paris, France, 7 University of Paris, Paris, France, 8 Institut de Médecine et d'Épidémiologie Appliquée, Paris, France, 9 Sorbonne University, Paris, France, 10 Amsterdam University Medical Centers, Amsterdam, Netherlands Background: As two-drug antiretroviral therapy (ART) and long-acting injectable ART become more commonly prescribed forms of HIV treatment, some people with HIV-hepatitis B virus (HBV) coinfection may soon be transitioned off tenofovir-containing ART. We characterized HBV virological and serological outcomes in people with HIV-HBV who discontinue or never initiate tenofovir. Methods: We conducted a secondary analysis of data from the prospective French HIV-HBV Cohort Study of participants with a minimum of 6 years of follow-up. We divided participants into three treatment groups: (1) continuous tenofovir; (2) discontinued tenofovir; (3) never initiated tenofovir. We examined

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