Mücke V T, Mücke M M, Peiffer K-H, Weiler N, Welzel T M, Sarrazin C, Zeuzem S, Berger A, Vermehren J
Medizinische Klinik 1, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany.
Institut für Klinische Virologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany.
Aliment Pharmacol Ther. 2017 Aug;46(4):432-439. doi: 10.1111/apt.14177. Epub 2017 Jun 19.
Hepatitis B virus (HBV) reactivation has been observed following interferon (IFN)-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 (DAAs).
To investigate the rate of patients with HBV reactivation during IFN-based and IFN-free HCV treatment in a large real-world cohort.
A total of 848 patients with chronic hepatitis C were treated with different combinations of DAAs. Among patients with available outcome and HBV data, there were 272 patients hepatitis B core antibody (HBcAb)-positive (HBsAg-positive, n=9; HBsAg-negative, n=263), and 536 were HBcAb-negative. All HBcAb-positive patients were tested for HBV DNA at the end of DAA therapy and alanine transaminase (ALT) levels were frequently measured during therapy and follow-up.
Seventy-three percent (n=192/263) 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. Eight patients had detectable but not quantifiable HBV DNA (<20 IU/mL) at end of treatment, but none were associated with elevated ALT. Five of nine HBsAg-positive/HBcAb-positive patients experienced transient or permanent HBV reactivation, three of whom required nucleos(t)ide treatment during (n=1) or after (n=2) DAA therapy.
HBV reactivation was not observed in HBsAg-negative/HBcAb-positive patients but common in HBsAg-positive/HBcAb-positive patients treated with different combinations of DAAs for HCV.
在乙肝病毒（HBV）/丙肝病毒（HCV）合并感染患者接受基于干扰素（IFN）的治疗后，已观察到HBV再激活现象。近期报告表明，在使用直接抗病毒药物（DAA）治疗HCV期间，乙肝表面抗原（HBsAg）阳性和HBsAg阴性患者中也可能发生再激活。
在一个大型真实世界队列中，调查基于IFN和不使用IFN的HCV治疗期间HBV再激活患者的比例。
共有848例慢性丙型肝炎患者接受了不同组合的DAA治疗。在有可用结局和HBV数据的患者中，272例患者乙肝核心抗体（HBcAb）阳性（HBsAg阳性，n = 9；HBsAg阴性，n = 263），536例为HBcAb阴性。所有HBcAb阳性患者在DAA治疗结束时检测HBV DNA，并在治疗和随访期间频繁测量丙氨酸转氨酶（ALT）水平。
HBsAg阴性/HBcAb阳性患者中有73%（n = 192/263）在基线时ALT水平升高，除18例患者外，其余患者的ALT水平均降至正常，未观察到HBV再激活。8例患者在治疗结束时可检测到但无法定量的HBV DNA（<20 IU/mL），但均与ALT升高无关。9例HBsAg阳性/HBcAb阳性患者中有5例经历了短暂或永久性HBV再激活，其中3例在DAA治疗期间（n = 1）或之后（n = 2）需要接受核苷（酸）治疗。
在接受不同组合DAA治疗HCV的HBsAg阴性/HBcAb阳性患者中未观察到HBV再激活，但在HBsAg阳性/HBcAb阳性患者中较为常见。
