Hepatitis B Reactivation with Direct-Acting Antiviral Hepatitis C Therapy

“I refuse to accept the view that mankind is so tragically bound to the starless midnight of racism and war that the bright daybreak of peace and brotherhood can never become a reality.” Martin Luther King, Jr

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More information on hepatitis B virus (HBV) reactivation with direct-acting antiviral (DAA) hepatitis C virus (HCV) therapy has been published:

  • PS Belperio et al. Hepatology 2017; 66: 27-36
  • G Chen et al Hepatology 2017; 66: 13-26
  • Editorial: RP Perrillo. G Chen et al Hepatology 2017; 66: 4-6.

In a previous post on this topic (:), it was noted that physicians need to be aware of HBV reactivation with DAAs. It appears that HCV can suppress HBV replication and that successful HCV therapy allows for HBV reactivation.

Belperio et al reviewed data from an observational study on more than 62,000 HCV-infected veterans, including 377 who had HBsAg-positivity and 7295 who had anti-HBc-positivity.

Key findings:

  • 8 of 377 HBsAg-positive had reactivation (defined as HBV DNA increase of >1000 IU/mL) of HBV during DAA treatment of HCV. Only one of these eight had a severe hepatitis (ALT 154o IU)
  • 1 of 7295 HBc-positive had HBV reactivation. This rate of reactivation is actually lower than HBV reactivation reported with ‘inactive’ disease (1-2% per year).
  • For HBV screening, the authors recommend HBsAg and anti-HBc testing

Chen et al performed a systematic review (of 28 studies included) and meta-analysis had identified overt  HBV reactivation in 12.2% of those receiving DAAs.  This was a lower rate of HBV reactivation than with interferon (14.5%); however, reactivation during DAA therapy occurred earlier (typically 4-12 weeks into treatment) and was more clinically significant. There was significant variation in the virologic and ALT criteria used to define HBV reactivation.  The authors conclude that it is “important to have HBV serology (HBsAg, anti-HBc) in all HCV patients prior to therapy.

Perillo recommends that in addition to screening, “it is my belief that anti-HBV prophylaxis be given to all HBsAg-positive patients, ” regardless of HBV DNA level.

My take: These articles help quantitate the risk of HBV reactivation during HCV therapy.

Ben Sawyer Bridge, Sullivans Island

Related blog posts:

Swing bridge, Ben Sawyer Bridge, Sullivans Island

 

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