Hepatitis B virus reactivation among hepatitis C patients treated with direct-acting antiviral therapies in routine clinical practice
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Elisabetta Loggi1, Stefano Gitto2, Silvia Galli3
1Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy; Unità Operativa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy.
Insights
Hepatitis B reactivation risk in chronic hepatitis C patients on direct-acting antiviral therapy is low, especially for those with past HBV infection. Monitoring HBV-DNA is recommended for HBsAg-positive patients during DAA treatment.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Hepatitis B (HBV) reactivation is a potential risk in chronic hepatitis C (CHC) patients receiving direct-acting antiviral (DAA) therapies.
- Further data are needed to understand the clinical impact of this risk.
Purpose of the Study:
- To analyze the occurrence of HBV reactivation in a cohort of CHC patients treated with DAAs in routine clinical practice.
- To assess the clinical significance of HBV reactivation during DAA therapy.
Main Methods:
- Retrospective analysis of 137 CHC patients treated with IFN-free DAAs.
- HBV serology (HBsAg, anti-HBc) and HBV-DNA testing at baseline and 24 weeks post-treatment in anti-HBc positive patients.
- HBsAg testing post-treatment for HBV-DNA positive cases.
Main Results:
- Of 44 anti-HBc positive patients, two were HBsAg-positive; one showed HBV-DNA increase but no clinical impact and achieved HBsAg loss.
- No HBV reactivation was observed in HBsAg-negative patients with past HBV exposure.
Conclusions:
- Past HBV infection does not appear to predispose CHC patients to HBV reactivation during DAA therapy.
- Regular HBV-DNA monitoring is recommended for HBsAg-positive patients not on suppressive antiviral treatment during DAA therapy.
Background:
Hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients treated with IFN-free direct acting antiviral (DAA) therapies has recently emerged as a potential risk. Given the potential burden of this issue, further data are needed to establish its actual clinical impact.
Objectives:
The aim of the present study was to analyze the occurrence of HBV reactivation in a cohort of CHC patient treated with DAAs in routine clinical practice.
Study Design:
Consecutive CHC patients with different genotypes, treated with DAA between January 2015 and January 2016 were included in the study. Subjects had been tested for HBsAg and anti-HBc antibodies before antiviral therapy. HBV-DNA levels were examined in anti-HBc positive patients at baseline and 24 weeks after the end of treatment. Post-treatment HBsAg determination was performed in case of HBV-DNA positivity. Serum anti-HBs kinetics was analysed in anti-HBs and anti-HBc positive subjects.
Results:
A cohort of 137 consecutive HCV patients treated with IFN-free regimens in routine clinical practice was evaluated. From this cohort, plasma samples of 44 subjects with positive serology for HBV (anti-HBc positive) were tested for HBV-DNA levels at baseline and 24 weeks after the end of treatment. Two of them were HBsAg-positive, while the others had signs of a past HBV exposure (HBsAg-negative±HBsAb-positive). No reactivation was found in HBcAb-positive and HBsAg-negative subjects. In the two HBsAg-positive, one experienced an increase in HBV-DNA levels of ≥2 log10 IU/mL during treatment. However, the reactivation was without clinical impact and, most important, was followed by HBsAg loss.
Conclusions:
Based on our experience, a past HBV infection seems not to be a condition predisposing to HBV reactivation. On the contrary, in HBsAg-positive subjects not in suppressive treatment with nucleos(t)ide analogs, regular monitoring of HBV-DNA during and after DAA treatment should be considered.
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