Departments of Medicine.
Gastroenterology.
J Clin Gastroenterol. 2018 Nov/Dec;52(10):908-912. doi: 10.1097/MCG.0000000000000986.
Direct acting antiviral (DAA) agents are the standard of care for treatment of hepatitis C virus (HCV)-infected individuals. Hepatitis B virus (HBV) reactivation during HCV treatment has been reported, the incidence and clinical outcome remains unclear. The aim of our study is to examine the risk of HBV reactivation in actively infected or previously exposed patients during or after HCV treatment with DAAs.
Adults with chronic HCV infection previously exposed or actively infected with HBV and treated with DAAs between December 2015 to 2016 were included. Electronic medical records were reviewed for HCV treatment dates, HCV treatment response, DAA used, HBV status, and concurrent HBV treatment. Primary end-point was to determine the risk of HBV reactivation during or up to 3 months after DAA treatment.
We identified 283 patients, and 100% of patients completed HCV treatment with ledipasvir-sofosbuvir. 93% had HCV genotype-1 of whom 91% achieved sustained viral response at 12 weeks posttreatment (SVR-12). In total, 7% had HCV genotype-4 who achieved SVR-12 of 84%. Mean (±SD) age was 59.7 (±7) years, and 58% were male. A total of 45% of patients had hepatitis B core antibody (HBcAb) positive and hepatitis B surface antigen (HBsAg) negative. In total, 55% of patients had a positive HBsAg before HCV DAA treatment. No HBV reactivation was encountered in the (HBcAb) positive HBsAg-negative cohort nor in the (HBsAg) positive group with 95% confidence interval (0-0.023) and (0-0.019), respectively.
In our study of patients with HCV and isolated hepatitis B core or HBsAg positivity, no HCV patients treated with DAA experienced HBV reactivation.
直接作用抗病毒（DAA）药物是治疗丙型肝炎病毒（HCV）感染个体的标准治疗方法。已有报道称，在 HCV 治疗期间会发生乙型肝炎病毒（HBV）再激活，但其发生率和临床结局尚不清楚。本研究旨在研究在接受 DAA 治疗 HCV 期间或之后，HBV 活跃感染或既往暴露的患者发生 HBV 再激活的风险。
纳入 2015 年 12 月至 2016 年期间接受 DAA 治疗的既往有 HBV 活跃感染或既往暴露且慢性 HCV 感染的成年人。回顾电子病历以获取 HCV 治疗日期、HCV 治疗反应、使用的 DAA、HBV 状态和同时进行的 HBV 治疗。主要终点是确定 DAA 治疗期间或治疗后 3 个月内 HBV 再激活的风险。
我们共确定了 283 例患者，所有患者均完成了 ledipasvir-sofosbuvir 治疗 HCV。93%的患者 HCV 基因型为 1 型，其中 91%在治疗后 12 周（SVR-12）时达到持续病毒学应答。总共 7%的患者 HCV 基因型为 4 型，其中 84%达到 SVR-12。平均（±SD）年龄为 59.7（±7）岁，58%为男性。共有 45%的患者乙型肝炎核心抗体（HBcAb）阳性，乙型肝炎表面抗原（HBsAg）阴性。总共 55%的患者在 HCV DAA 治疗前 HBsAg 阳性。在 HBcAb 阳性 HBsAg 阴性队列中或 HBsAg 阳性组中均未发现 HBV 再激活，95%置信区间（0-0.023）和（0-0.019）分别为（0-0.023）和（0-0.019）。
在我们的研究中，对于 HCV 合并孤立性乙型肝炎核心或 HBsAg 阳性的患者，没有接受 DAA 治疗的 HCV 患者发生 HBV 再激活。
