At CROI 2025, Dr. Anchalee Avihingsanon and her colleagues reported Week 48 outcomes from the open-label extension phase of the ALLIANCE study. The data show that adults with HIV/HBV coinfection who switched to bictegravir-emtricitabine-tenofovir alafenamide (B/F/TAF; Biktarvy, Gilead) after taking another antiretroviral therapy maintained high rates of virologic suppression for both viruses.


Meaghan Lee Callaghan: Are there things that you would say for providers who are treating  someone with an HIV–HBV coinfection? Anything else that you've gleaned from this?

Anchalee Avihingsanon, MD, PhD: Yes. So when we [are] treating coinfection, we have to think about two viruses’ interaction. So it's not just focus on HIV only. The hepatitis B treatment outcome is also very important because a patient can develop ketoacidosis or hepatocellular carcinoma later on. So we should select the best ART [antiretroviral therapy] for them at the beginning or even during the course of treatment. So always think about two infections in patients with a high risk of hepatitis B who are co-infected patients and also not just that for this population, they have worse hepatitis B outcomes, and also they have high risk of hepatotoxicity with ART, and also high risk of renal toxicity.

MLC: Pretty impressive findings, especially with hepatitis B, were you surprised by what you found?


Dr. Avihingsanon: Oh, yes, very much because we don't think that with a long term of HIV suppression, and then at the time of switch to TAF, so it still has the effect of TAF over hepatitis B outcome. So this means that when you start TAF at the beginning is much, much better. But in a patient who were on TDF it's not too late to switch to TAF regimen.

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