TheBodyPro | What to know about hepatitis B when switching to tenofovir-sparing antiretroviral regimens

TheBodyPro clinical overview

As we more frequently prescribe injectables, two-drug therapies, and other novel antiretroviral regimens, a growing proportion of those regimens lack tenofovir. Because tenofovir is used to treat hepatitis B virus (HBV) and is partially protective against new HBV infection, providers need to consider the risk of new or reactivated HBV before switching a patient to a tenofovir-sparing regimen.

“I think we are very much in, and entering, an era where increasingly more therapeutic options for antiretroviral therapy and PrEP are going to be without tenofovir,” said H. Nina Kim, M.D., M.Sc., a professor of medicine at University of Washington’s Division of Allergy and Infectious Diseases. Kim co-authored a viewpoint paper this May in Clinical Infectious Diseases highlighting the issue so that clinicians can protect patients against potentially harmful reactivations and new HBV infections.

“Many of these reactivations may be subclinical with mild rise in liver enzymes,” Kim said. “But it can cause rip-roaring, acute liver injury to the point where you might ultimately need a liver transplant — or it might cause death.” The point isn’t to cause alarm but rather to be aware. “It’s probably an infrequent event and depends on your profile,” she said, “But the reason why we’re paying attention to this is because the stakes are kind of high.”

Serological testing is thus warranted before switching to tenofovir-sparing regimens — whether the patient is receiving treatment, prevention taking part in a clinical trial.

Read the full overview here.