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  • 1.  ART issues in those with HBcAb+, HBsAg -

    Posted 01-05-2022 01:38

    Any qualms about stopping antiretrovirals with intrinsic anti-hep B activity in PLWH or PrEP patients who are Hep B core Ab (IgG) positive, sAg negative?


    My understanding is that people with HBcAb are at risk of Hep B reactivation, regardless of HBsAb status. The highest risk is with those getting Rituxan, or higher dose steroids, but the risk is low, not zero, even for folks without immunosuppressive comorbidities or meds.


    PLWH might be eligible for regimen simplification with 0-1 drugs with anti-hep B activity. If HBcAb +, HBsAg -, would you still offer Cabenuva or Juluca, or Dovato, assuming they met all other criteria for regimen change? Would current or nadir CD4 count affect your decision?


    For PrEP patients HBcAb+, HBsAg-, any concerns about stopping PrEP? I believe iPrEX had six patients who were HBcAb+, sAg+ who got Truvada, and none with Hep B flares after stopping Truvada. That was only six patients though, but I'd think HBsAg- patients would be less risk of reactivation anyway.


    Anyone seen any cases of Hep B reactivation in these situations?


    Thank you for any input!

    Steve Burrows, MD, FAAFP, AAHIVS

    Steve Burrows
    Group Health
    Mill Creek WA

  • 2.  RE: ART issues in those with HBcAb+, HBsAg -

    Posted 01-06-2022 11:16
    If the surface antibody is positive the risk of reactivation quite low and only a concern if significant immunosuppression is present or anticipated. If the surface antibody is negative vaccination can be considered, with the understanding that we are discussing surface antigen negative patients . Remember that all serologic tests have a false positivity propensity which is significantly greater in IgM antibody testing. You may or may not be aware of the core antibody testing that was performed.
    What to do in a unique situation is always subject to artful consideration. Informed consent requiring patient involvement in decision making always a good rule. All medicines cause problems in some patients and all medicines do not cause any recognizable problem in many patients.
    I, personally, am always reluctant to change an existing working regimen recognizing that problems that a patient is experiencing not recognized to be related to the medication could in fact be related ... Hence, if a patient is requesting a change I usually begin the conversation by stressing the benefits of the current regimen.
    Regards ,
    David M. Bebinger, MD
    University of Massachusetts Medical School
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