Spaan Michelle, Bruce Matthew, Agarwal Kosh, Carey Ivana
Institute of Liver Studies, King's College Hospital, London, United Kingdom.
Antivir Ther. 2018;23(6):539-542. doi: 10.3851/IMP3259.
Hepatitis B reactivation in patients with resolved HBV can occur during hepatitis C treatment with direct-acting antivirals, but only a few cases have been described. It is not clear which patients are at risk for HBV reactivation and how to manage them.
Three patients (all hepatitis B surface antigen [HBsAg]-negative, antibody to hepatitis B core [anti-HBc] positive and HBV DNA negative) experienced a late HBV reactivation 12 weeks post-treatment but were able to control their viraemia. HCV RNA, HBV DNA, anti-HBc and anti-HBs were measured in these patients and in 37 HBsAg-negative, anti-HBc positive, HBV DNA negative control patients during direct-acting antiviral therapy for chronic hepatitis C.
Baseline anti-HBs do not differ between patients with and without HBV reactivation. Patients with HBV reactivation, however, significantly increased their anti-HBs at time of reactivation, while patients without HBV reactivation show stable anti-HBs during therapy (P=0.007).
Anti-HBs might be an important marker to delineate patients at risk for clinically significant HBV reactivation.
已治愈乙肝患者在接受丙肝直接抗病毒治疗期间可能发生乙肝再激活，但仅有少数病例被报道。目前尚不清楚哪些患者有乙肝再激活风险以及如何对其进行管理。
3例患者（均为乙肝表面抗原[HBsAg]阴性、乙肝核心抗体[抗-HBc]阳性且HBV DNA阴性）在治疗后12周出现迟发性乙肝再激活，但能够控制病毒血症。在这些患者以及37例HBsAg阴性、抗-HBc阳性、HBV DNA阴性的对照患者接受慢性丙肝直接抗病毒治疗期间，检测了HCV RNA、HBV DNA、抗-HBc和抗-HBs。
有和没有乙肝再激活的患者基线抗-HBs无差异。然而，乙肝再激活患者在再激活时抗-HBs显著升高，而无乙肝再激活的患者在治疗期间抗-HBs保持稳定（P=0.007）。
抗-HBs可能是界定有临床显著乙肝再激活风险患者的重要标志物。
