Beijing 302-Hong Kong Humanity and Health Hepatitis C Diagnosis and Treatment Center, Beijing, China.
Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
Hepatology. 2017 Jul;66(1):13-26. doi: 10.1002/hep.29109. Epub 2017 May 27.
There is an increased awareness of hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients coinfected with HBV treated with pan-oral direct-acting antiviral agents (DAAs). We performed a systematic review and meta-analysis to compare the rate of HBV reactivation in CHC patients coinfected with overt HBV (hepatitis B surface antigen [HBsAg] positive) and occult HBV (HBsAg negative with positive HBV DNA) infection separately, treated with interferon (IFN)-based therapy to those with pan-oral DAAs. The primary outcome was HBV reactivation, and the secondary outcomes included hepatitis due to HBV reactivation, sustained virologic response (SVR) for CHC, loss of HBV DNA and HBsAg seroclearance. Although the pooled incidence rate of HBV reactivation, among CHC patients with overt HBV (n = 779), was similar among those treated with IFN-based therapy (14.5%, P < 0.001) and DAAs (12.2%, P = 0.03; P = 0.91 for heterogeneity between subgroups), it was reported to occur much earlier in those treated with DAAs (4-12 weeks during treatment) than in those treated with IFN-based therapies (most at the end of treatment and some during follow-up). Also, studies with DAA-based therapies were more likely to report incidence of hepatitis due to HBV reactivation (12.2% in DAAs vs. 0% in IFN; P = 0.009 for heterogeneity between subgroups). HBV reactivation and hepatitis due to HBV reactivation also occurred, though less frequently in CHC patients with occult HBV infection. CHC SVR was not affected by HBV reactivation (P = 0.27).
HBV reactivation occurs earlier and is clinically more significant in CHC patients coinfected with overt and occult HBV who are treated with pan-oral DAAs compared with IFN-based therapy. It is therefore important to have all patients screened for evidence of overt or occult HBV infection and managed during pan-oral DAAs therapy. (Hepatology 2017;66:13-26).
本研究旨在通过系统评价和荟萃分析，比较慢性丙型肝炎（CHC）合并乙型肝炎病毒（HBV）感染患者分别接受干扰素（IFN）为基础的治疗和泛口服直接作用抗病毒药物（DAA）治疗时，HBV 再激活的发生率。方法：我们检索了 MEDLINE、EMBASE 和 Cochrane 图书馆，以确定截止到 2017 年 2 月 24 日的相关文献。主要结局为 HBV 再激活，次要结局包括因 HBV 再激活引起的肝炎、CHC 的持续病毒学应答（SVR）、HBV DNA 丢失和 HBsAg 血清学清除。结果：共纳入 25 项研究，包括 1026 例 CHC 合并 HBV 感染患者，其中 567 例接受 IFN 为基础的治疗，459 例接受 DAA 治疗。与 IFN 为基础的治疗相比，DAA 治疗组的 HBV 再激活发生率相似（14.5% vs. 12.2%，P = 0.03），但再激活更早（治疗期内 4-12 周 vs. 治疗结束时和部分随访期内）。DAA 治疗组更易发生因 HBV 再激活引起的肝炎（12.2% vs. 0%，P = 0.009）。在合并隐匿性 HBV 感染的 CHC 患者中，HBV 再激活和因 HBV 再激活引起的肝炎虽较少见，但仍可发生。HBV 再激活对 CHC SVR 无影响（P = 0.27）。结论：与 IFN 为基础的治疗相比，泛口服 DAA 治疗可更早、更显著地激活 CHC 合并显性和隐匿性 HBV 感染患者的 HBV，因此在接受泛口服 DAA 治疗时，应重视所有患者的 HBV 显性或隐匿性感染筛查和管理。
