Potential risk of HBV reactivation in patients with resolved HBV infection undergoing direct-acting antiviral treatment for HCV

Liver Int. 2018 Jan;38(1):76-83. doi: 10.1111/liv.13496. Epub 2017 Jun 29.

Abstract

Background & aims: Despite a known risk of hepatitis B virus (HBV) reactivation during direct-acting antiviral (DAA) treatment for patients with hepatitis C virus (HCV)-HBV coinfection, it remains unclear whether patients with past HBV infection are at risk for reactivation. This study evaluated the risk of HBV reactivation during treatment with sofosbuvir (SOF)-based regimens, focusing on patients with resolved HBV infection.

Methods: This study analyzes the data of 183 consecutive patients treated with SOF-based regimens. From these patients, 63 with resolved HBV infection (negative for hepatitis B surface antigen [HBsAg] and undetectable HBV DNA but positive for hepatitis B core antibody) were eligible for this study. HBV reactivation was defined as a quantifiable HBV DNA level >20 IU/mL.

Results: Among the patients antibody to HBsAg (anti-HBs) positive (10-500 mIU/mL) (n = 30), the titre of anti-HBs was significantly decreased with time, as shown by the results of repeated-measures analysis of variance (P = .0029). Overall, four patients (6.3%) with resolved HBV infection came to have detectable HBV DNA during treatment, including one who had HBV reactivation at week 4 (HBV DNA 80 IU/mL). However, none developed hepatic failure. Among four patients who had detectable HBV DNA during treatment, all were negative or had very low-titre (<20 mIU/mL) anti-HBs at baseline.

Conclusions: The titre of anti-HBs was significantly decreased from the early stage of DAA treatment. Chronic hepatitis C patients with resolved HBV infection and negative or very low-titre anti-HBs at baseline are at risk for having detectable HBV DNA transiently during treatment.

Keywords: direct-acting antivirals; hepatitis B virus reactivation; hepatitis C virus; resolved HBV infection; sofosbuvir.

MeSH terms

  • Aged
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Benzimidazoles / therapeutic use
  • DNA, Viral / blood
  • DNA, Viral / genetics
  • Female
  • Fluorenes / therapeutic use
  • Hepacivirus / drug effects*
  • Hepacivirus / pathogenicity
  • Hepatitis B / blood
  • Hepatitis B / diagnosis
  • Hepatitis B / virology*
  • Hepatitis B Antibodies / blood
  • Hepatitis B virus / drug effects*
  • Hepatitis B virus / genetics
  • Hepatitis B virus / immunology
  • Hepatitis C, Chronic / diagnosis
  • Hepatitis C, Chronic / drug therapy*
  • Hepatitis C, Chronic / virology
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Ribavirin / therapeutic use
  • Risk Assessment
  • Risk Factors
  • Sofosbuvir / therapeutic use
  • Time Factors
  • Treatment Outcome
  • Virus Activation / drug effects*

Substances

  • Antiviral Agents
  • Benzimidazoles
  • DNA, Viral
  • Fluorenes
  • Hepatitis B Antibodies
  • ledipasvir
  • Ribavirin
  • Sofosbuvir