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Reactivation of hepatitis B in patients of chronic hepatitis C with hepatitis B virus infection treated with direct acting antivirals.

Reactivation of hepatitis B in patients of chronic hepatitis C with hepatitis B virus infection treated with direct acting antivirals.
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Yeh ML, Huang CF, Hsieh MH, Ko YM, Chen KY, Liu TW, Lin YH, Liang PC, Hsieh MY, Lin ZY, Chen SC, Huang CI, Huang JF, Kuo PL, Dai CY, Yu ML, Chuang WL,


Yeh ML, Huang CF, Hsieh MH, Ko YM, Chen KY, Liu TW, Lin YH, Liang PC, Hsieh MY, Lin ZY, Chen SC, Huang CI, Huang JF, Kuo PL, Dai CY, Yu ML, Chuang WL, (click to view)

Yeh ML, Huang CF, Hsieh MH, Ko YM, Chen KY, Liu TW, Lin YH, Liang PC, Hsieh MY, Lin ZY, Chen SC, Huang CI, Huang JF, Kuo PL, Dai CY, Yu ML, Chuang WL,

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Journal of gastroenterology and hepatology 2017 02 23() doi 10.1111/jgh.13771
Abstract
BACKGROUND AND AIMS
Hepatitis B virus (HBV) may reactivate when treating chronic hepatitis C (CHC) with direct acting antivirals (DAA). We aim to investigate the risk of HBV reactivation during DAA therapy.

METHODS
CHC patients receiving pan-oral DAA therapy from Dec. 2013 to Aug. 2016 were evaluated. Fifty-seven patients that had a past HBV infection (negative hepatitis B surface antigen (HBsAg)) and positive hepatitis B core antibody (Anti-HBc)) and 7 patients that had a current HBV infection (positive HBsAg) were enrolled. Serum HBV and hepatitis C virus (HCV) markers were regularly measured. The endpoints were the HCV sustained virological response (SVR) and the HBV virological/clinical reactivation.

RESULTS
The overall SVR12 rate was 96.9%, and 2 patients, one with positive HBsAg, had a relapse of HCV. No episodes of HBV virological reactivation were observed among the patients with a past HBV infection. For the 7 patients with a current HBV infection, HBV virological reactivation was found in 4 (57.1%) of the 7 patients. Clinical reactivation of HBV was observed in one patient with pre-treatment detectable HBV DNA and recovered after entecavir administration. For the other 3 patients with HBV virological reactivation, the reappearance of low level HBV DNA without clinical reactivation was observed. HBsAg levels demonstrated only small fluctuations in all the patients.

CONCLUSIONS
There was a minimal impact of Anti-HBc seropositivity on HCV efficacy and safety. For CHC patients with current HBV infection, the risk of HBV reactivation was present and monitoring the HBV DNA level during therapy is warranted.

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