Hepatitis B virus (HBV) reactivation has been observed following interferon-based treatment in HBV/hepatitis C virus (HCV) co-infected patients.
Recent reports suggest that reactivation may also occur in both hepatitis B surface antigen (HBsAg)-positive and HBsAg-negative patients during HCV treatment with direct-acting antivirals.
Dr Vermehren and colleagues from Germany investigated the rate of patients with HBV reactivation during interferon-based and interferon-free HCV treatment in a large real-world cohort.
A total of 848 patients with chronic hepatitis C were treated with different combinations of direct-acting antivirals.
|73% of HBsAg-negative/HBcAb-positive patients had elevated ALT levels at baseline|
|Alimentary Pharmacology & Therapeutics|
Among patients with available outcome and HBV data, there were 272 patients hepatitis B core antibody (HBcAb)-positive, and 536 were HBcAb-negative.
All HBcAb-positive patients were tested for HBV DNA at the end of direct-acting antiviral therapy and alanine transaminase (ALT) levels were frequently measured during therapy and follow-up.
The team found that 73% of HBsAg-negative/HBcAb-positive patients had elevated ALT levels at baseline, which declined to normal values in all but 18 patients, and no HBV reactivation was observed.
There were 8 patients that had detectable but not quantifiable HBV DNA at end of treatment, but none were associated with elevated ALT.
The research team observed that 5 of 9 HBsAg-positive/HBcAb-positive patients experienced transient or permanent HBV reactivation, 3 of whom required nucleotide treatment during or after direct-acting antiviral therapy.
Dr Vermehren's team concludes, "HBV reactivation was not observed in HBsAg-negative/HBcAb-positive patients but common in HBsAg-positive/HBcAb-positive patients treated with different combinations of direct-acting antivirals for HCV."