Hepatitis B Virus Reactivation in People With HIV After Treatment With Non-hepatitis B Virus-Active Antiretroviral Therapy

(See the Major Article by Denyer et al on pages e735–42.) HIV and hepatitis B virus (HBV) are chronic viral infections that share many routes of transmission [1]. For people with HIV who acquire HBV, a variable proportion resolve HBV infection and have serological evidence of past exposure to HBV without chronic infection. In fact, the serologic profile of negative HBV surface antigen (HBsAg) and positive HBV core antibody (HBcAb) with or without HBV surface antibody (HBsAb), indicating likely past exposure to HBV, is present in approximately one-third of people with HIV in non-HBV-endemic countries and up to two-thirds in HBV-endemic countries [1, 2]. People with negative HBsAg but positive HBcAb and HBsAb are sometimes referred to as having “resolved” HBV, though this may be a misnomer because many people with this serologic profile have the potential for HBV reactivation (ie, HBV DNA increase or HBsAg sero-reversion) especially in the context of immunosuppression [1].