We all have patients who just don't get a sAb response to hepatitis B (HBV) vaccination even with repeat vaccination or higher-dose vaccine. A recent retrospective look at rates of incident HBV infection in a cohort of HIV-positive men who have sex with men who were on ART indicates that tenofovir may function as prophylaxis. It found that use of tenofovir as part of the ART regimen was associated with a sharply lower rate of HBV infection (0.14 infections/100 patient-years vs 2.85 if the ART included no HBV-active drugs, and 1.36 if 3TC was the only HBV-active drug in the regimen). Further data will be needed to support this finding, but these results appear quite promising.
Heuft MM, Houba SM, van den Berk GE, et al. Protective effect of hepatitis B virus-active antiretroviral therapy against primary hepatitis B virus infection. AIDS. 2014 Apr 24;28(7):999-1005.