Graduate Institute of Medicine, Kaohsiung Medical University, Taiwan.
School of Medicine, Kaohsiung Medical University, Taiwan.
J Infect Dis. 2019 Apr 8;219(8):1224-1233. doi: 10.1093/infdis/jiy648.
We aimed to investigate the long-term outcomes in hepatitis B (HBV)/hepatitis C virus (HCV) dual-infected patients after anti-HCV therapy.
A total of 192 HBV/HCV dual-infected patients who had received pegylated interferon treatment were recruited. The investigation outcomes included HBV DNA ≥2000 IU/mL, with or without alanine aminotransferase (ALT) ≥2-fold the upper limit of normal, and hepatitis B surface antigen (HBsAg) seroclearance.
Four (2.1%) patients developed early HBV reactivation before the end of treatment. Fifty (26.6%) of the remaining patients had an episode of HBV DNA ≥2000 IU/mL in a mean follow-up of 68.8 months. The risk was 4.6 per 100 person years. Only 19 (10.1%) patients developed concomitant ALT flare with oral HBV antiviral therapy; the risk was 1.7 per 100 person years. Despite HBV flare, 67 (34.9%) patients had a favorable outcome of HBsAg seroclearance. The probability was 5.7 per 100 person years. A pretreatment HBV DNA level of 300 IU/mL served as an independent predictor for all the outcomes. The combined pretreatment HBV DNA level and HCV response further enhanced the prediction of HBV flare and HBsAg seroclearance.
A pretreatment HBV DNA level of 300 IU/mL predicts HBV flare and HBsAg seroclearance after anti-HCV therapy.
本研究旨在探讨慢性乙型肝炎（HBV）/丙型肝炎病毒（HCV）双重感染患者接受抗 HCV 治疗后的长期结局。
共纳入 192 例接受聚乙二醇干扰素治疗的 HBV/HCV 双重感染患者。研究结局包括 HBV DNA≥2000IU/ml，伴或不伴丙氨酸氨基转移酶（ALT）≥2 倍正常值上限，以及乙肝表面抗原（HBsAg）血清学清除。
4 例（2.1%）患者在治疗结束前发生早期 HBV 再激活。50 例（26.6%）患者在平均 68.8 个月的随访中发生 HBV DNA≥2000IU/ml。风险为 4.6/100 人年。仅有 19 例（10.1%）患者在口服 HBV 抗病毒治疗时发生同时伴有 ALT 升高的 HBV 复发；风险为 1.7/100 人年。尽管 HBV 复发，但 67 例（34.9%）患者仍获得 HBsAg 血清学清除的良好结局。概率为 5.7/100 人年。治疗前 HBV DNA 水平为 300IU/ml 是所有结局的独立预测因素。治疗前 HBV DNA 水平与 HCV 反应的联合可进一步增强对 HBV 复发和 HBsAg 血清学清除的预测。
治疗前 HBV DNA 水平为 300IU/ml 可预测抗 HCV 治疗后 HBV 复发和 HBsAg 血清学清除。
