Virological reactivation of the hepatitis B virus after simplification of antiretroviral treatment.

INTRODUCTION: Between 5% and 10% of people living with HIV (PLWH) have chronic hepatitis B virus (HBV) infection. Withdrawal of anti-HBV agents during antiretroviral therapy (ART) simplification may increase the risk of viral reactivation. METHODS: We report two cases of PLWH with serological evidence of past HBV infection (isolated anti-HBc positivity) who developed HBV reactivation after switching to dual ART regimens lacking anti-HBV activity. RESULTS: A 63-year-old woman developed detectable HBV DNA (659 IU/mL) one month after starting cabotegravir/rilpivirine, and a 55-year-old man showed reactivation (2626 IU/mL) after switching to dolutegravir/rilpivirine. In both cases, reintroduction of anti-HBV therapy achieved viral suppression. CONCLUSIONS: ART simplification without HBV-active agents may be associated with HBV DNA reappearance in patients with prior exposure. The clinical significance of low-level viremia remains uncertain, and further studies are needed.