Risk of hepatitis B virus reactivation in hepatitis B virus?+?hepatitis C virus‐co‐infected patients with compensated liver cirrhosis treated with ombitasvir, paritaprevir/r?+?dasabuvir?+?ribavirin

摘要

Summary Hepatitis B virus may reactivate in patients with chronic hepatitis C treated with direct‐acting antivirals. The aim of this study was to investigate the risk of hepatitis B virus ( HBV ) reactivation in HBV ?+?hepatitis C virus ( HCV )‐co‐infected patients with compensated liver cirrhosis treated with paritaprevir/ombitasvir/ritonavir, dasabuvir with ribavirin. We reviewed prospectively gathered data from a national cohort of 2070 hepatitis C virus patients with compensated liver cirrhosis who received reimbursed paritaprevir/ombitasvir/r, dasabuvir with ribavirin for 12?weeks from the Romanian National Health Agency during 2015‐2016. Twenty‐five patients in this cohort were HB s antigen positive (1.2%); 15 untreated with nucleotide analogues agreed to enter the study. These patients were followed up: ALT monthly, serology for HBV and DNA viral load at baseline, EOT and SVR at 12?weeks. Hepatitis B virus ( HBV )‐co‐infected patients were all genotype 1b and 52% females, with a median age of 60?years (51?÷?74); 76% were pretreated with peginterferon?+?ribavirin; 72% were with severe necroinflammatory activity on FibroMax assessment; 40% presented comorbidities; and all were HB e antigen negative. Hepatitis C virus ( HCV ) SVR response rate was 100%. Hepatitis B virus ( HBV )‐ DNA viral load was undetectable in 7/15 (47%) before therapy, and for the other 8 patients, it varied between below 20 and 867? IU /mL. Five patients (33%) presented virological reactivation (2 log increase in HBV ‐ DNA levels) during therapy. One patient presented with hepatitis associated with HBV reactivation, and two started anti‐ HBV therapy with entecavir. Hepatitis B virus ( HBV ) virological reactivation was present in 33% in our patients. Generally, HBV ‐ DNA elevations were mild (20?000? IU /mL); however, we report one case of hepatitis associated with HBV reactivation.