HBV Reactivation Rare After Stopping Tenofovir
NEW late-breaking data presented at the 2025 European AIDS Clinical Society (EACS) Congress indicate that stopping tenofovir in people with HIV who have past hepatitis B exposure poses little clinical risk. In the Swiss HIV Cohort Study, hepatitis B surface antigen (HBsAg)-negative but core antibody (HBcAb)-positive participants who transitioned to tenofovir-sparing antiretroviral therapy (ART) showed a very low rate of detectable hepatitis B virus (HBV) DNA after 1 year.
The study examined 380 participants who discontinued tenofovir after a median of 4.5 years on therapy. Participants were matched 1:1 by age, sex, and duration on tenofovir into two groups: those who switched to regimens without HBV-active agents (non-lamivudine or emtricitabine; ‘non-XTC’ group) and those who switched to XTC-containing ART. Stored plasma samples were analysed before and after the switch, using high-sensitivity HBV DNA assays to detect viral reactivation.
Before stopping tenofovir, just 1–2% of participants had detectable HBV DNA. After a median follow-up of 1.3 years, HBV DNA was detected in 5.3% of those on non-XTC ART and 1.6% of those on XTC ART (p=0.048). Importantly, all detectable results remained below the quantification threshold, indicating extremely low viral activity.
HBV Markers Stable, Supporting Safe Tenofovir-Sparing ART
At follow-up, 3.4% of HBcAb-positive participants who switched to non-tenofovir therapy had any detectable HBV DNA, yet none experienced significant hepatitis or required clinical intervention. Rates of elevated liver enzymes were comparable between those with and without detectable HBV DNA, suggesting no clinical sequelae of reactivation.
The findings provide reassuring evidence that HBV reactivation is uncommon and of minimal clinical concern when switching virologically suppressed people with HIV to tenofovir-sparing ART. The data support growing confidence in the safety of non-tenofovir treatment strategies, particularly in ageing populations where renal and bone toxicities are a concern.
Researchers emphasised that continued monitoring of HBV markers remains prudent, especially in those with advanced liver disease or other risk factors, but the results offer valuable real-world evidence supporting flexibility in long-term ART design.
Reference
Begré L et al. Low risk of HBV reactivation in HBcAb-positive/HBsAg-negative persons with HIV switching to non-tenofovir-based antiretroviral therapy. PS15.6.LB. EACS 2025, 15-18 October, 2025.
