Occult HBV Reactivation Risk — SCE Infectious Diseases MCQ

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HardHIV MedicineOccult HBV Reactivation RiskSCE Infectious Diseases

A 34-year-old man with HIV (CD4 580, VL <50 on BIC/TAF/FTC) is incidentally found to have an isolated positive Hepatitis B core antibody (anti-HBc positive, HBsAg negative, anti-HBs negative). He plans to switch ART to a regimen without Tenofovir or Emtricitabine. His HBV DNA is undetectable. What risk must be communicated before switching?

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Correct answer: E — Risk of HBV reactivation — occult HBV may reactivate if HBV-active agents (Tenofovir/Emtricitabine) are withdrawn without alternative HBV cover

Isolated anti-HBc in HIV-positive patients may represent occult HBV infection (low-level HBV DNA integrated or present at levels below detection). TAF/FTC in his current regimen provides HBV suppression. Withdrawing these agents without alternative HBV cover risks HBV reactivation with potential hepatic flare. BHIVA recommends checking HBV DNA before switching and either maintaining HBV-active agents or adding Entecavir. If HBV DNA is truly undetectable and there is no evidence of active HBV, the risk is lower but not zero — monitoring with HBV DNA and LFTs post-switch is essential.

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