HBV HBV reactivation in patients with HCV HCV / HBV HBV cirrhosis on treatment with direct‐acting antivirals

摘要

Summary Anecdotal reports suggest that patients with chronic hepatitis C virus ( HCV ) hepatitis and overt or occult hepatitis B virus ( HBV ) coinfection may reactivate HBV when HCV is suppressed or cleared by direct‐acting antivirals ( DAA s). We assessed the prevalence of overt or previous HBV coinfection and the risk of HBV reactivation in patients with HCV cirrhosis treated with DAA s. This was a retrospective cohort of 104 consecutive patients with HCV cirrhosis treated with DAA s. Serum HCV ‐ RNA and HBV ‐ DNA were tested at weeks 4, 8 and 12 of DAA s therapy and at week 12 of follow‐up. At the start of DAA s, eight patients (7.7%) were HB sAg positive/ HB eAg negative with undetectable HBV ‐ DNA and low levels of quantitative HB sAg (four on nucleos(t)ide analogues [ NUC s] and four inactive carriers), 37 patients (35.6%) had markers of previous HBV infection (25 anti‐ HB c positive, 12 anti‐ HB c/anti‐ HB s positive) and 59 (56.7%) had no evidence of HBV infection. Sixty‐seven patients (64.4%) were HCV ‐ RNA negative at week 4 and 98 (94.2%) achieved sustained virological response. All four HB sAg‐positive patients treated with NUC s remained HBV ‐ DNA negative, but three of four untreated patients showed an increase in HBV ‐ DNA of 2‐3 log without a biochemical flare and achieved HBV ‐ DNA suppression when given NUC s. During or after DAA s, by conventional assay, HBV ‐ DNA remained not detectable in all 37 anti‐ HB c‐positive patients but in three of them (8.1%) HBV ‐ DNA became detectable with a highly sensitive PCR . HBV reactivation is likely to occur in untreated HBV / HCV ‐coinfected cirrhotic patients when they undergo HCV treatment with DAA s. Pre‐emptive therapy with NUC s should be considered in this setting. Anti‐ HB c‐positive patients rarely reactivate HBV without clinical or virological outcomes.