HBV Reactivation — SCE Infectious Diseases MCQ

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ModerateHepatitisHBV ReactivationSCE Infectious Diseases

A 45-year-old man with HIV (CD4 480, VL <50 on DTG/TAF/FTC) is co-infected with chronic hepatitis B (HBsAg+, HBV DNA undetectable on his tenofovir-containing ART). His clinician considers switching his ART to a non-tenofovir regimen for convenience. What is the critical risk?

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Correct answer: E — HBV reactivation flare — potentially fatal hepatic decompensation if tenofovir-active agents are withdrawn without alternative HBV coverage

In HIV/HBV co-infection, Tenofovir (DF or AF) and Emtricitabine/Lamivudine provide dual antiviral activity against HBV. Withdrawing these agents without ensuring continued HBV suppression risks severe HBV reactivation with potentially fatal hepatic flare, even in patients with previously undetectable HBV DNA. If ART is switched to a non-tenofovir regimen, alternative HBV-active therapy (e.g. Entecavir) must be added. BHIVA strongly warns against this scenario.

Reference: BHIVA 2025 – ART guidelines; BHIVA 2023 – Hepatitis B/HIV co-infection