Infectious Diseases and Therapy · Published 2026-05-23 · DOI 10.1007/s40121-026-01366-9
Alberto Foncillas, Lorena De La Mora, Leire Berrocal, Elisa de Lazzari, Júlia Calvo, Abiu Sempere, Ivan Chivite, Alexy Inciarte, Maria Martínez-Rebollar, Berta Torres, Ana González-Cordón, Jose Luís Blanco, José. M. Miró, Esteban Martínez, Montserrat Laguno, Josep Mallolas, Juan Ambrosioni
Abstract Introduction The increasing adoption of tenofovir (TXF)-sparing antiretroviral therapy (ART) raises concerns regarding hepatitis B virus (HBV) susceptibility and reactivation risk among people with HIV (PWH). We characterized HBV serological profiles and vaccination status according to ART composition in a real-world cohort. Methods A cross-sectional study of all PWH in active follow-up at Hospital Clínic, Barcelona, as of 30 June 2025. ART regimens were categorized as TXF-containing or TXF-sparing, with or without lamivudine (3TC). HBV serological patterns were classified as chronic infection, serologically resolved infection, isolated HBV core antibody (anti-HBc), no exposure/immunity, and vaccine-induced immunity. Demographic and clinical characteristics were compared using nonparametric and chi-squared/Fisher’s tests. Results Among the 6437 participants included (82% cisgender men; median age 48 years [IQR 39–58]), 3519 (55%) received TXF-containing and 2918 (45%) TXF-sparing regimens, of whom 1702/2918 (58%) were with 3TC. HBV serological distribution was: 2% chronic infection, 26% serologically resolved infection, 5% isolated anti-HBc, 52% vaccine-induced immunity, and 15% without exposure/immunity (50% documented prior vaccination attempts, 32% nonresponders, and 31% with prior anti-HBs detection). Overall, 1280 (20%) lacked protective HBV immunity (isolated anti-HBc or negative serology for all markers), including 530 (41%) on TXF-free regimens. TXF recipients were younger (47 versus 50 years, p < 0.001), more often migrants (58% versus 49%, p < 0.001), had lower suppression rates (91% versus 97%, p < 0.001), a higher proportion of previous virological failure(s) (26% versus 21%, p < 0.001), and a lower number of prior ART regimens (median 3 versus 4, p < 0.001). Conclusions One in five PWH lacked effective HBV immunity, including 41% of whom were receiving TXF-sparing strategies. In the context of increasing use of TXF-sparing strategies, improvements in systematic HBV screening, vaccination, and risk-based monitoring are essential to prevent HBV-related morbidity.
Abstract from DOAJ. Public domain (CC0 1.0).
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Foncillas, A., Mora, L., Berrocal, L., et al. (2026). HBV Serological Profiles and Vaccination Status in People with HIV in the Transition to a Tenofovir-Sparing Era: Insights from a Large HIV Cohort. Infectious Diseases and Therapy. https://doi.org/10.1007/s40121-026-01366-9