Top Journal Analysis | Unveiling the Importance of HBV RNA in HIV Co-infected Individuals

Globally, approximately 15–30% of HIV-infected individuals exhibit serological characteristics of anti-HBc (antibody to HBV core protein) positivity and HBsAg (HBV surface antigen) negativity, which may reflect the presence of occult HBV infection. In the context of HIV infection, this occult infection is particularly significant, as HIV-associated immunodeficiency may reduce immune control over HBV replication, leading to its persistence. This persistence can potentially accelerate liver disease progression. Therefore, monitoring HBV replication dynamics in individuals co-infected with HIV and HBV is critical for optimizing treatment strategies. Recently, a study from the Second University of Rome, published in the International Journal of Infectious Diseases, explored the role of HBV RNA in HIV-positive but HBsAg-negative individuals after discontinuation of tenofovir disoproxil fumarate/tenofovir alafenamide (TDF/TAF).

The study included 101 HIV-infected individuals who were anti-HBc positive and HBsAg negative. These individuals switched to non-TDF/TAF treatment regimens after discontinuing TDF/TAF. Serum levels of HBV DNA and HBV RNA were measured using droplet digital PCR (ddPCR) technology at the time of treatment discontinuation (T0), within 12 months post-discontinuation (T1), and 12–24 months post-discontinuation (T2).

At T0, 22% of the patients were HBV RNA positive, indicating that HBV viral replication remained active even under HBsAg-negative status and TDF/TAF treatment pressure (Figure 1).

Figure 1

At T2, the proportion of HBV RNA-positive patients increased from 22% to 38.5%, indicating that during the 12–24 months following treatment discontinuation, the replication activity of the HBV reservoir had increased compared to the time of discontinuation (Figure 2).

Figure 2

This study underscores the importance of regular monitoring for anti-HBc positive/HBsAg negative HIV-infected individuals and highlights the role of highly sensitive HBV markers in optimizing patient management. Continuous monitoring of HBV RNA levels could be key to tracking cccDNA activity and evaluating HBV replication dynamics. With ongoing research, we can look forward to developing more precise monitoring tools and therapeutic strategies to improve the prognosis of these patients.

The HBV nucleic acid assay kit independently developed by Rendu Biotech has been the first to receive approval for market release due to its unique detection technology, high sensitivity, and high specificity. Unlike traditional PCR techniques, this kit utilizes a proprietary SAT technology—RNA real-time fluorescent isothermal amplification—which enables direct amplification and quantification of RNA molecules without interference from HBV DNA in the sample. This eliminates the need for DNase treatment and achieves a detection limit as low as 50 copies/mL. Coupled with the AutoSAT fully automated platform, it minimizes manual operation errors, saves laboratory resources, and provides robust support for the management of hepatitis B patients.