Long-term quantitative hepatitis B surface antigen (HBsAg) trajectories in persons with and without HBsAg loss on tenofovir-containing antiretroviral therapy

HIV Med. 2024 Feb;25(2):291-298. doi: 10.1111/hiv.13561. Epub 2023 Oct 10.


Objectives: Improving the understanding of the patterns of quantitative hepatitis B surface antigen (qHBsAg) trajectories associated with HBsAg loss is important in light of novel anti-hepatitis B virus agents being developed. We evaluated long-term qHBsAg trajectories in persons with HIV and HBV during tenofovir-containing antiretroviral therapy in the Swiss HIV Cohort Study.

Methods: We included 29 participants with and 29 without HBsAg loss, defined as qHBsAg <0.05 IU/mL. We assessed qHBsAg decline during therapy in both groups and used agglomerative hierarchical clustering to identify different qHBsAg trajectory profiles in persons with HBsAg loss.

Results: The median follow-up time was 11.9 years (IQR 8.4-14.1), and the median time to HBsAg loss was 48 months (IQR 12-96). Among participants with HBsAg loss, 79% had a qHBsAg decline ≥1 log10 IU/mL 2 years after starting tenofovir. The trajectories in qHBsAg levels during tenofovir therapy were heterogeneous, characterized by five distinct profiles. Among participants without HBsAg loss, only 7% had a qHBsAg decline ≥1 log10 IU/ml after 2 years.

Conclusions: Most persons with HIV who experienced HBsAg loss had an early decline in qHBsAg levels, with diverse trajectories during long-term tenofovir therapy. In persons without HBsAg loss, qHBsAg levels remained remarkably stable over time.

Keywords: HBsAg; HIV; hepatitis B; tenofovir; trajectories.

MeSH terms

  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • DNA, Viral
  • HIV Infections* / drug therapy
  • Hepatitis B Surface Antigens / therapeutic use
  • Hepatitis B e Antigens / therapeutic use
  • Hepatitis B, Chronic* / drug therapy
  • Humans
  • Tenofovir / therapeutic use


  • Tenofovir
  • Hepatitis B Surface Antigens
  • Antiviral Agents
  • Hepatitis B e Antigens
  • DNA, Viral