Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy; Unità Operativa di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria Sant'Orsola-Malpighi, Bologna, Italy.
Dipartimento di Scienze Mediche e Chirurgiche & Centro Studi Ricerche sulle Epatiti, Programma Dipartimentale ITEC, Azienda Ospedaliero-Universitaria Policlinico di Sant'Orsola, Bologna, Italy.
J Clin Virol. 2017 Aug;93:66-70. doi: 10.1016/j.jcv.2017.05.021. Epub 2017 Jun 3.
Hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients treated with IFN-free direct acting antiviral (DAA) therapies has recently emerged as a potential risk. Given the potential burden of this issue, further data are needed to establish its actual clinical impact.
The aim of the present study was to analyze the occurrence of HBV reactivation in a cohort of CHC patient treated with DAAs in routine clinical practice.
Consecutive CHC patients with different genotypes, treated with DAA between January 2015 and January 2016 were included in the study. Subjects had been tested for HBsAg and anti-HBc antibodies before antiviral therapy. HBV-DNA levels were examined in anti-HBc positive patients at baseline and 24 weeks after the end of treatment. Post-treatment HBsAg determination was performed in case of HBV-DNA positivity. Serum anti-HBs kinetics was analysed in anti-HBs and anti-HBc positive subjects.
A cohort of 137 consecutive HCV patients treated with IFN-free regimens in routine clinical practice was evaluated. From this cohort, plasma samples of 44 subjects with positive serology for HBV (anti-HBc positive) were tested for HBV-DNA levels at baseline and 24 weeks after the end of treatment. Two of them were HBsAg-positive, while the others had signs of a past HBV exposure (HBsAg-negative±HBsAb-positive). No reactivation was found in HBcAb-positive and HBsAg-negative subjects. In the two HBsAg-positive, one experienced an increase in HBV-DNA levels of ≥2 log IU/mL during treatment. However, the reactivation was without clinical impact and, most important, was followed by HBsAg loss.
Based on our experience, a past HBV infection seems not to be a condition predisposing to HBV reactivation. On the contrary, in HBsAg-positive subjects not in suppressive treatment with nucleos(t)ide analogs, regular monitoring of HBV-DNA during and after DAA treatment should be considered.
在接受无干扰素直接作用抗病毒（DAA）治疗的慢性丙型肝炎（CHC）患者中，乙型肝炎（HBV）再激活最近成为一个潜在的风险。鉴于这一问题的潜在负担，需要进一步的数据来确定其实际的临床影响。
本研究旨在分析在常规临床实践中接受 DAA 治疗的 CHC 患者队列中 HBV 再激活的发生情况。
连续纳入了 2015 年 1 月至 2016 年 1 月期间接受 DAA 治疗的不同基因型的 CHC 患者。所有患者在抗病毒治疗前均接受 HBsAg 和抗-HBc 抗体检测。在治疗结束后 24 周时，对抗-HBc 阳性患者进行 HBV-DNA 水平检测。在 HBV-DNA 阳性的情况下，对 HBsAg 进行治疗后检测。在抗-HBs 和抗-HBc 阳性的患者中分析血清抗-HBs 动力学。
评估了在常规临床实践中接受无干扰素方案治疗的 137 例连续 CHC 患者的队列。从该队列中，对 44 例 HBV 血清学检测结果为阳性（抗-HBc 阳性）的患者的血浆样本进行了基线和治疗结束后 24 周的 HBV-DNA 水平检测。其中 2 例为 HBsAg 阳性，而其他患者则有 HBV 既往暴露的迹象（HBsAg 阴性±HBsAb 阳性）。在 HBcAb 阳性和 HBsAg 阴性的患者中未发现再激活。在这 2 例 HBsAg 阳性的患者中，1 例在治疗期间 HBV-DNA 水平增加了≥2 log IU/mL。然而，再激活没有临床影响，最重要的是，随后 HBsAg 丢失。
根据我们的经验，既往 HBV 感染似乎不是导致 HBV 再激活的条件。相反，在未接受核苷（酸）类似物抑制治疗的 HBsAg 阳性患者中，在 DAA 治疗期间和之后应定期监测 HBV-DNA。
