Risks and benefits of oral HIV pre-exposure prophylaxis for people with chronic hepatitis B

Lancet HIV. 2022 Aug;9(8):e585-e594. doi: 10.1016/S2352-3018(22)00123-0. Epub 2022 Jul 8.

Abstract

Individuals with chronic hepatitis B virus (HBV) infection who are at substantial risk of HIV acquisition benefit from pre-exposure prophylaxis (PrEP) with tenofovir-based antiviral therapy. Considering that tenofovir potently inhibits HBV, providing PrEP to individuals with HBV effectively results in treatment of their HBV infection. However, some clinicians might be hesitant to initiate PrEP in people with chronic HBV due to unknown risks of HBV reactivation, hepatitis, and acute liver failure during periods of antiviral cessation. Unfortunately, these knowledge gaps affect scale up of PrEP among people with chronic HBV. Emerging data regarding the risks and benefits of antiviral cessation in people with chronic HBV suggest that PrEP can be safely initiated despite the risks of non-adherence or discontinuation. People with chronic HBV who stop PrEP should be closely monitored for HBV reactivation and hepatitis flares after antiviral cessation.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antiviral Agents / therapeutic use
  • HIV Infections* / drug therapy
  • HIV Infections* / prevention & control
  • Hepatitis B virus
  • Hepatitis B* / drug therapy
  • Hepatitis B, Chronic* / drug therapy
  • Hepatitis B, Chronic* / prevention & control
  • Humans
  • Pre-Exposure Prophylaxis* / methods
  • Risk Assessment
  • Tenofovir / therapeutic use

Substances

  • Antiviral Agents
  • Tenofovir