David Ha, PharmD

In patients co-infected with hepatitis B and HIV, entecavir should be avoided, and a tenofovir-based regimen active against both viruses is preferred.

When a patient tests positive for total hepatitis B core antibody but negative for both surface antigen and surface antibody, additional workup is essential to distinguish between resolved infection, occult disease, early infection, or a false positive result.

An undetectable viral load does not mean hepatitis B is cured, and discontinuing antiviral therapy can trigger severe immune-mediated liver damage.

For patients with a creatinine clearance below 15 mL/min or intolerance to tenofovir-based therapies, entecavir remains a viable and well-supported treatment option per the 2026 American Association for the Study of Liver Disease and Infectious Diseases Society of America guidelines.

For patients with HIV who fail to mount adequate immunity after a standard aluminum-adjuvanted hepatitis B vaccine series, switching to the cytosine-guanine-adjuvanted Heplisav-B offers superior immunogenicity and more reliable protection.

Household and sexual contacts of patients with hepatitis B should be vaccinated regardless of contact type, with post-vaccination antibody testing reserved for those at highest ongoing risk.