Douglas T Dieterich, Laurence Brunet, Ricky K Hsu, Karam Mounzer, Gerald Pierone, Michael B Wohlfeiler, Jennifer S Fusco, Megan S Dunbar, Joshua Gruber, Leland J Yee, Catherine Frenette, Travis Lim, Gregory P Fusco
{"title":"替诺福韦在HIV和HBV患者中的中断：HBV监测和HBV再激活和肝炎爆发的风险。","authors":"Douglas T Dieterich, Laurence Brunet, Ricky K Hsu, Karam Mounzer, Gerald Pierone, Michael B Wohlfeiler, Jennifer S Fusco, Megan S Dunbar, Joshua Gruber, Leland J Yee, Catherine Frenette, Travis Lim, Gregory P Fusco","doi":"10.1097/QAD.0000000000004353","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To assess HBV monitoring, HBV reactivation and hepatitis flares during tenofovir interruptions among people with HIV and HBV.</p><p><strong>Design: </strong>Cohort study of electronic health records.</p><p><strong>Methods: </strong>All tenofovir (tenofovir disoproxil fumarate, tenofovir alafenamide) interruptions among people with HIV and positive HBV surface antigen (HBsAg) or positive HBV core antibody (HBcAb) were categorized by reactivation risk (high: HBsAg+; moderate: HBsAg-/HBcAb+/surface antibody [HBsAb] negative; low: HBsAg-/HBcAb+/HBsAb+). Incidence rates of HBV reactivation and hepatitis flare were assessed with Poisson regression.</p><p><strong>Results: </strong>Among 5343 individuals with HIV and HBV, there were 6252 tenofovir interruptions (11% high-, 19% moderate-, 69% low-risk). During the interruptions, HBV DNA/HBsAg testing was infrequent (high: 52%/25%; moderate: 8%/31%, low: 5%/28%), although ALT testing was performed during nearly all interruptions. The HBV reactivation rate was 9.59 per 100 person-years (95% confidence interval [CI]: 7.91, 11.64) during high-risk, 0.58 (0.36, 0.91) during moderate-risk, and 0.04 (0.02, 0.11) during low-risk interruptions. The HBV reactivation with hepatitis flare incidence rate was much lower, especially in the high-risk group (3.06 per 100 person-year; 95% CI: 2.19, 4.29).</p><p><strong>Conclusions: </strong>In this large US cohort of people with HIV and HBV, tenofovir interruptions were common and HBV monitoring was sub-optimal. HBV reactivation rates were highest among the high-risk group, but much lower among the moderate- and low-risk groups. However, some reactivations were likely missed due to low monitoring frequency. Primary and HIV care providers must incorporate HBV monitoring in their standard of care and proceed with caution if considering a tenofovir interruption for people with HIV and HBV.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tenofovir interruption among people with HIV and HBV: HBV monitoring and risk of HBV reactivation and hepatitis flare.\",\"authors\":\"Douglas T Dieterich, Laurence Brunet, Ricky K Hsu, Karam Mounzer, Gerald Pierone, Michael B Wohlfeiler, Jennifer S Fusco, Megan S Dunbar, Joshua Gruber, Leland J Yee, Catherine Frenette, Travis Lim, Gregory P Fusco\",\"doi\":\"10.1097/QAD.0000000000004353\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess HBV monitoring, HBV reactivation and hepatitis flares during tenofovir interruptions among people with HIV and HBV.</p><p><strong>Design: </strong>Cohort study of electronic health records.</p><p><strong>Methods: </strong>All tenofovir (tenofovir disoproxil fumarate, tenofovir alafenamide) interruptions among people with HIV and positive HBV surface antigen (HBsAg) or positive HBV core antibody (HBcAb) were categorized by reactivation risk (high: HBsAg+; moderate: HBsAg-/HBcAb+/surface antibody [HBsAb] negative; low: HBsAg-/HBcAb+/HBsAb+). Incidence rates of HBV reactivation and hepatitis flare were assessed with Poisson regression.</p><p><strong>Results: </strong>Among 5343 individuals with HIV and HBV, there were 6252 tenofovir interruptions (11% high-, 19% moderate-, 69% low-risk). During the interruptions, HBV DNA/HBsAg testing was infrequent (high: 52%/25%; moderate: 8%/31%, low: 5%/28%), although ALT testing was performed during nearly all interruptions. The HBV reactivation rate was 9.59 per 100 person-years (95% confidence interval [CI]: 7.91, 11.64) during high-risk, 0.58 (0.36, 0.91) during moderate-risk, and 0.04 (0.02, 0.11) during low-risk interruptions. The HBV reactivation with hepatitis flare incidence rate was much lower, especially in the high-risk group (3.06 per 100 person-year; 95% CI: 2.19, 4.29).</p><p><strong>Conclusions: </strong>In this large US cohort of people with HIV and HBV, tenofovir interruptions were common and HBV monitoring was sub-optimal. HBV reactivation rates were highest among the high-risk group, but much lower among the moderate- and low-risk groups. However, some reactivations were likely missed due to low monitoring frequency. Primary and HIV care providers must incorporate HBV monitoring in their standard of care and proceed with caution if considering a tenofovir interruption for people with HIV and HBV.</p>\",\"PeriodicalId\":7502,\"journal\":{\"name\":\"AIDS\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-09-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"AIDS\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/QAD.0000000000004353\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"AIDS","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAD.0000000000004353","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Tenofovir interruption among people with HIV and HBV: HBV monitoring and risk of HBV reactivation and hepatitis flare.
Objective: To assess HBV monitoring, HBV reactivation and hepatitis flares during tenofovir interruptions among people with HIV and HBV.
Design: Cohort study of electronic health records.
Methods: All tenofovir (tenofovir disoproxil fumarate, tenofovir alafenamide) interruptions among people with HIV and positive HBV surface antigen (HBsAg) or positive HBV core antibody (HBcAb) were categorized by reactivation risk (high: HBsAg+; moderate: HBsAg-/HBcAb+/surface antibody [HBsAb] negative; low: HBsAg-/HBcAb+/HBsAb+). Incidence rates of HBV reactivation and hepatitis flare were assessed with Poisson regression.
Results: Among 5343 individuals with HIV and HBV, there were 6252 tenofovir interruptions (11% high-, 19% moderate-, 69% low-risk). During the interruptions, HBV DNA/HBsAg testing was infrequent (high: 52%/25%; moderate: 8%/31%, low: 5%/28%), although ALT testing was performed during nearly all interruptions. The HBV reactivation rate was 9.59 per 100 person-years (95% confidence interval [CI]: 7.91, 11.64) during high-risk, 0.58 (0.36, 0.91) during moderate-risk, and 0.04 (0.02, 0.11) during low-risk interruptions. The HBV reactivation with hepatitis flare incidence rate was much lower, especially in the high-risk group (3.06 per 100 person-year; 95% CI: 2.19, 4.29).
Conclusions: In this large US cohort of people with HIV and HBV, tenofovir interruptions were common and HBV monitoring was sub-optimal. HBV reactivation rates were highest among the high-risk group, but much lower among the moderate- and low-risk groups. However, some reactivations were likely missed due to low monitoring frequency. Primary and HIV care providers must incorporate HBV monitoring in their standard of care and proceed with caution if considering a tenofovir interruption for people with HIV and HBV.
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Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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