Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA.
Hepatology. 2017 Jul;66(1):27-36. doi: 10.1002/hep.29135. Epub 2017 May 18.
Reactivation of hepatitis B virus (HBV) has been reported in hepatitis C virus-infected individuals receiving direct-acting antiviral (DAA) therapy. The overall risk among patients with current or prior HBV infection in the context of DAA treatment is unknown. The aim of this evaluation was to identify and characterize HBV reactivation among veterans treated with oral DAA therapy. This retrospective evaluation included 62,290 hepatitis C virus-infected veterans completing oral DAA treatment. Baseline HBV infection status for each veteran was identified from HBV laboratory data performed prior to DAA initiation. To assess for HBV reactivation and hepatitis we identified all hepatitis B surface antigen (HBsAg), HBV DNA, and alanine aminotransferase results obtained while on DAA treatment or 7 days after. HBV reactivation was defined as a >1000 IU/mL increase in HBV DNA or HBsAg detection in a person who was previously negative. Prior to DAA treatment 85.5% (53,784/62,920) had HBsAg testing and 0.70% (377/53,784) were positive; 84.6% (53,237/62,920) had a hepatitis B surface antibody test, of which 42.2% (22,479/53,237) were positive. In all, 9 of 62,290 patients treated with DAAs had evidence of HBV reactivation occurring while on DAA treatment. Eight occurred in patients known to be HBsAg-positive, and 1 occurred in a patient known to be isolated hepatitis B core antibody-positive. Seventeen other patients had small increases in HBV DNA levels that did not qualify as HBV reactivation. Only 3 of the 9 patients identified with HBV reactivation in this cohort exhibited peak alanine aminotransferase elevations >2 times the upper limit of normal.
HBV reactivation of varying severity, even in the setting of isolated hepatitis B core antibody, with or without accompanying hepatitis can occur-though the occurrence of accompanying severe hepatitis was rare. (Hepatology 2017;66:27-36).
在接受直接作用抗病毒（DAA）治疗的丙型肝炎病毒感染个体中，已报告乙型肝炎病毒（HBV）再激活。在 DAA 治疗背景下，当前或既往 HBV 感染患者的总体风险尚不清楚。本评估的目的是确定并描述接受口服 DAA 治疗的退伍军人中的 HBV 再激活情况。这项回顾性评估纳入了 62290 名完成口服 DAA 治疗的丙型肝炎病毒感染退伍军人。每位退伍军人的基线 HBV 感染状态根据 DAA 启动前进行的 HBV 实验室数据确定。为了评估 HBV 再激活和肝炎，我们确定了在 DAA 治疗期间或之后 7 天内获得的所有乙型肝炎表面抗原（HBsAg）、HBV DNA 和丙氨酸氨基转移酶结果。HBV 再激活定义为以前为阴性的患者 HBV DNA 或 HBsAg 检测值增加>1000 IU/mL。在接受 DAA 治疗之前，85.5%（53784/62920）接受了 HBsAg 检测，其中 0.70%（377/53784）为阳性；84.6%（53237/62920）接受了乙型肝炎表面抗体检测，其中 42.2%（22479/53237）为阳性。在接受 DAA 治疗的 62290 名患者中，有 9 名患者出现 DAA 治疗期间 HBV 再激活的证据。其中 8 例发生在已知 HBsAg 阳性的患者中，1 例发生在已知单独乙型肝炎核心抗体阳性的患者中。其他 17 例患者的 HBV DNA 水平略有升高，但未达到 HBV 再激活的标准。在本队列中确定的 9 名 HBV 再激活患者中，仅有 3 名出现丙氨酸氨基转移酶峰值升高>2 倍正常值上限。
即使在单独乙型肝炎核心抗体的情况下，也会出现不同严重程度的 HBV 再激活，伴或不伴伴随性肝炎——尽管伴随严重肝炎的发生罕见。（《肝脏病学》2017；66：27-36）。
