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HBV Reactivation Flare — SCE Infectious Diseases MCQ

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ModerateHepatitisHBV Reactivation FlareSCE Infectious Diseases

A 42-year-old man with HIV on ART develops chronic hepatitis B flare after inadvertently stopping his Tenofovir-containing regimen. ALT is 1,800 U/L, bilirubin 120 µmol/L, and INR 1.8. What has occurred and what is the management?

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Correct answer: A — HBV reactivation flare due to withdrawal of Tenofovir's HBV-suppressive effect; restart Tenofovir-containing ART immediately and monitor for hepatic decompensation

Stopping Tenofovir (which suppresses both HIV and HBV) in an HIV/HBV co-infected patient causes loss of HBV suppression, leading to HBV rebound viraemia and immune-mediated hepatic flare. This can cause severe hepatitis, hepatic decompensation, and death. The Tenofovir-containing ART must be restarted immediately. This scenario is a critical safety issue and is why BHIVA strongly warns against stopping HBV-active agents without alternative HBV cover in co-infected patients.

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