Numerous linked cases of acute genotype F hepatitis B virus infections in people living with HIV or on pre-exposure prophylaxis.
Abstract
Objectives
At least 2.7 million people living with HIV are infected with HBV worldwide. Some antiretroviral treatments and tenofovir disoproxil fumarate-based Pre-Exposure Prophylaxis (PrEP) protect against HBV infection. However, emerging antiretroviral (ARV) strategies without any activity against HBV may promote spread of this virus in the future. In this context, we studied recent cases of acute HBV infection in people at risk of sexually transmitted infections. Our objective was to better understand HBV circulation and the dynamics of its transmission.
Methods
This retrospective study included people diagnosed with acute hepatitis B virus infections between 2022 and 2025 in France. The whole HBV genome was amplified and sequenced by NGS for network analysis.
Results
Sixteen men, with a median age of 35 years, were enrolled. Six were living with HIV, including three receiving long-acting injectable cabotegravir/rilpivirine treatment. Four of the HIV-negative individuals were taking PrEP. Nine had been vaccinated against HBV, and six had anti-HBs antibody titers between 10 and 100 IU/L. Analysis revealed HBV genotype F1b in 14 patients, with very high homology among the viruses. No known immune escape mutations were identified, even in the individuals with anti-HBs antibodies.
Conclusions
A transmission cluster of HBV F1b genotype was observed in a population at risk of infection. This genotype, which is endemic to Latin Ameria, is rarely detected in France. These findings may serve as a timely reminder of the ongoing circulation of HBV among exposed populations. HBV transmission among vaccinated individuals with positive anti-HBs antibodies raises questions and should be further studied.