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Management Of Patients With Hepatitis B Virus Reactivation Post-DAA Treatment Of Chronic Hepatitis C Virus Infection

Heba Ahmed Osman1, Ali A Ghweil1, Abeer Mm Sabry2

  • 1Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt.

Infection and Drug Resistance
|October 22, 2019
PubMed

Insights

Hepatitis C virus (HCV) and Hepatitis B virus (HBV) coinfection requires careful management. In coinfected patients with mild liver disease, direct-acting antiviral therapy for HCV can be safely completed without concurrent HBV antiviral treatment, provided close monitoring is in place.

Area of Science:

  • Hepatology
  • Virology
  • Internal Medicine

Background:

  • Hepatitis C virus (HCV)-HBV coinfection presents a significant clinical challenge, often leading to rapid liver disease progression.
  • Precise diagnosis and treatment strategies for coinfected patients remain critical for managing liver disease outcomes.

Purpose of the Study:

  • To investigate the role and safety of HBV antiviral therapy in patients experiencing HBV reactivation after direct-acting antiviral (DAA) therapy for HCV-HBV coinfection.
  • To evaluate the clinical course and outcomes of HCV-HBV coinfected patients undergoing DAA treatment without concomitant HBV antiviral therapy.

Main Methods:

  • A prospective randomized study involved 140 patients with chronic HCV and HBV coinfection.
  • Patients received sofosbuvir and daklatasvir for 3 months; all had pretreatment HBeAg seroconversion, low HBV DNA, normal liver enzymes, and mild hepatic fibrosis (F0/F1).
  • FibroScan, liver function tests, and viral load (HCV PCR, HBsAg, HBeAg) were assessed pretreatment, with follow-up at 1, 3, 6, and 12 months.

Main Results:

  • All 140 patients achieved sustained virologic response for HCV, with undetectable HCV PCR by 3 months post-treatment.
  • Four patients (2.8%) experienced HBV reactivation, characterized by elevated HBV DNA and liver enzymes.
  • These four patients showed significant improvement in liver enzymes, bilirubin, INR, and increased platelet count by 12 months post-treatment, with undetectable HBV PCR.

Conclusions:

  • Direct-acting antiviral therapy for HCV can be safely administered to coinfected patients with no/mild hepatic fibrosis, HBeAg seroconversion, and low HBV DNA levels.
  • Close monitoring is essential during HCV treatment in coinfected individuals, but concurrent HBV antiviral therapy may not be necessary in this specific patient group.
  • The study suggests that HBV reactivation, while occurring in a small subset, is manageable and does not preclude successful HCV treatment completion without preemptive HBV antiviral intervention.
Abstract

Keywords:
DAAsHBVHCVPCR

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