2026 Webinar – Viral Hepatitis and Sexual Health in LGBTQ+ Communities and Beyond ondemand-Prevention to Protection

Prevention to Protection

Pdf Summary

This presentation discusses the intersection of hepatitis B virus (HBV) and HIV pre-exposure prophylaxis (PrEP), especially in LGBTQ populations. HBV infection is more common in sexual minorities than in straight populations, and transgender people also face meaningful HBV burden. Because PrEP is widely used among MSM and other at-risk groups, hepatology and primary care clinicians should routinely assess sexual history, partner exposure, substance use, and viral hepatitis risk in an inclusive, nonjudgmental way.<br /><br />The talk reviews FDA-approved PrEP options. Oral tenofovir-based PrEP (emtricitabine/tenofovir disoproxil fumarate and emtricitabine/tenofovir alafenamide) has activity against HBV, while injectable options such as cabotegravir and lenacapavir do not. Oral PrEP may also lower HBV acquisition risk. In contrast, switching from tenofovir-based PrEP to tenofovir-sparing injectable PrEP can remove HBV protection, so HBV serologies should be checked before starting or stopping PrEP.<br /><br />Key management recommendations depend on HBV status:  <br />- If HBsAg-, anti-HBc-, anti-HBs-: vaccinate before switching off tenofovir-based PrEP, especially if susceptible.  <br />- If isolated anti-HBc: vaccination is not routinely required in immunocompetent patients, but liver test monitoring after stopping tenofovir may be considered.  <br />- If HBsAg positive: daily tenofovir-based PrEP is preferred because it treats HBV and prevents HIV; on-demand PrEP is not recommended. Stopping tenofovir in chronic HBV requires careful follow-up due to possible reactivation, though the risk after PrEP cessation appears low.<br /><br />Overall, the talk emphasizes “Don’t Drop the B”: prevent HIV while protecting against HBV, and maintain an affirming clinical environment for all patients.

Keywords

hepatitis B virus

HIV pre-exposure prophylaxis

PrEP

LGBTQ populations

tenofovir-based PrEP

cabotegravir

lenacapavir

HBV serologies

HBV vaccination

HBV reactivation