Risk of hepatitis B virus reactivation with direct‐acting antivirals against hepatitis C virus: A cohort study from Egypt and meta‐analysis of published data

摘要

Abstract Background & Aims Hepatitis B virus ( HBV ) reactivation in chronic hepatitis C ( CHC ) patients treated with direct‐acting antivirals ( DAA s) became an issue. However, its frequency has been poorly estimated, because of the varying definitions used and evaluation of heterogeneous study populations, including those concurrently treated for HBV . Methods We prospectively followed HBV surface antigen ( HB sAg)‐positive Egyptians undergoing interferon‐free DAA s, to estimate the risk of HBV reactivation and HBV ‐related hepatitis. We also conducted a meta‐analysis to estimate the reactivation risk using published data obtained from a systematic review of PubMed/Embase, in addition to our Egyptian data. We applied a standard definition of HBV reactivation proposed by the international liver associations ( APASL and AASLD ). Results Of 4471 CHC patients, 35 HB sAg‐positive patients started interferon‐free DAA s without HBV nucleos(t)ide analogues in our Egyptian cohort. Ten experienced HBV reactivation (28.6%), of whom 1 developed hepatitis (10.0%). Our systematic review identified 18 papers. The pooled reactivation risk in HB sAg‐positive patients was 18.2% (95% CI : 7.9%‐30.7%) without HBV therapy and 0.0% (95% CI : 0.0%‐0.0%) with HBV nucleos(t)ide analogue. The pooled risk of hepatitis in those with HBV reactivation was 12.6% (95% CI : 0.0%‐34.7%). The pooled reactivation risk in HB sAg‐negative, antibody to HBV core antigen‐positive (anti‐ HB c‐positive) patients was negligible (0.1%, 95% CI : 0.0%‐0.3%), irrespective of the presence of antibody to HB sAg (anti‐ HB s). Conclusions We confirmed high HBV reactivation risk in HB sAg‐positive patients undergoing DAA s, with only a minority developing clinically important hepatitis. The risk is negligible for HB sAg‐negative anti‐ HB c‐positive patients.