Truvada And Hepatitis B: Is It Safe to Take This Medication?

What is Truvada?

Truvada is a coformulation of Emtriva (emtricitabine) and Viread (tenofovir); two potent NRTIs used to treat HIV-1 infection. Truvada was granted U.S. FDA approval for the treatment of HIV and as pre-exposure prophylaxis treatment (PrEP). While each drug contained in Truvada is effective against hepatitis B infection (HBV), the combination regimen is not yet approved for such indication. Your doctor may still prescribe Truvada if you have HIV and HBV coinfection. Complications from hepatitis virus is the leading cause of death for people with HIV/AIDS in the United States.

Can you take Truvada if you have hepatitis B infection?

Truvada is often prescribed as off-label treatment for patients with HIV and concomitant HBV. In the iPrEx study, researchers analyzed a small subgroup with HBV and found that both emtricitabine and tenofovir in Truvada are also active against the hepatitis virus. IprEx was the first study that proved the effectiveness of PrEP among men who have sex with men (MSM) almost a decade ago. Out of 2,500 MSM and transgender women, there were six HBV-positive participants. The hepatitis B group did not experience liver inflammation, commonly referred to as “flares,” and other side effects after stopping treatment. The result from the study is pivotal, as PrEP has been thought to cause worsening of symptoms among patients with HBV coinfection, especially if adherence is suboptimal. However, hepatitis B management is a complex task, thus experts recommend that people with hepatitis B surface antigens must be referred to a specialist in the treatment of HBV before starting PrEP.

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Hepatitis B and HIV coinfection

Centers for Disease Control and Prevention (CDC) revealed that approximately 10% of people with HIV in the US also have hepatitis B. Patients with HIV/HBV coinfection should be treated for both diseases. HIV and HBV are both spread through contact with body fluids such as blood or semen. In the US, the most predominant way of HBV transmission in adults is through sexual contact. Person to person transmission can occur in the following scenarios:

1. Sharing injection drug equipment with someone who is infected by HBV;
2. Sharing personal items like toothbrushes or razors with people who have HBV;
3. Coming in contact with the blood or open sores of an HBV-infected person;
4. Accidental cut or prick from a needle or any sharp object contaminated with blood from an HBV patient;
5. Vertical transmission: mother to child during childbirth.

HIV and HBV share the same risk factors: injection drug use and condomless sex. Fortunately, for HBV, a hepatitis B vaccine is available to protect individuals from being infected. People with HIV should be tested for HBV even those who are not showing signs and symptoms. If you are at risk for HIV, CDC recommends getting the HBV vaccine. Your housemates and sexual partners must also get the vaccine to lower your chances of acquiring the virus. HBV vaccine can even protect you after accidental exposure to the virus, provided you get the shot (Hep B immune globulin) within 24 hours. Many people infected with HBV are asymptomatic and may look healthy, but they can still spread the virus to others. Hepatitis B immune globulin or HBIG is made of human blood samples containing antibodies against HBV. You can also get immunity from the virus if you had acute hepatitis B, and was cleared of the infection. Acute infection is a short-term infection, occurring within the first six months after exposure, which rarely lead to chronic infection. Chronic HBV is a lifelong infection; unfortunately, there is no cure if you have the condition. Over time, you may develop liver failure, cirrhosis, and liver cancer. People with chronic HBV can safely use Truvada PrEP. It can be safely offered to patients if there is no evidence of cirrhosis or significant transaminase elevation.

Unlike HIV, hepatitis B virus does not need to integrate into the host cell’s genetic code to replicate but once it does, it can trigger liver cancer. Long-term viral suppression using tenofovir significantly reduced the risk of developing liver cancer from HBV for over six years. Tenofovir is the current standard of care for patients with active chronic HBV infection. However, a recent study showed that the combination drug Truvada was more effective in achieving undetectable HBV DNA than with tenofovir alone. Both treatment was generally safe and well tolerated.