Wang Jing, Hu Chunhua, Chen Yi, Liu Zhengwen, Yu Qiang, Yang Shujuan, Dong Jun, Yang Yuan, Wu Yuchao, Ren Danfeng, Yao Naijuan, Guo Dandan, Tian Zhen, Zhao Yingren, Chen Tianyan, He Yingli, Liu Jinfeng
Department of Infectious Diseases, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an City, China.
Department of Rheumatology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an City, China.
Antivir Ther. 2019;24(2):77-84. doi: 10.3851/IMP3292.
There have been increasing reports of HBV reactivation in HBV and HCV coinfected patients with direct-acting antiviral (DAA) treatment. The potential risk of HBV reactivation in patients undergoing haemodialysis has also been noted. There is a lack of data pertaining to the reactivation risk during DAA treatment in those coinfected patients with end-stage renal disease who are undergoing haemodialysis.
HBV-HCV-coinfected patients were screened from 178 persons at two blood purification centres in China and received sofosbuvir (200 mg) combined with daclatasvir (60 mg) daily. The risk and pattern of HBV reactivation during DAA treatment was retrospectively analysed.
HBV reactivation occurred in 45.5% (5/11) of the HBV-HCV-coinfected patients undergoing haemodialysis during DAA treatment, which was much higher than the reported rates in the general population of coinfected patients. Five patients with HBV reactivation were all positive for hepatitis B surface antigen (HBsAg) before DAA treatment. Three patients (27.3%) had mild hepatitis flares due to HBV reactivation, but no patients had severe hepatitis or hepatic failure. Compared with the four patients who were HBsAg- at the baseline, the risk of HBV reactivation in HBsAg+ patients was greater (71.4% versus 0; χ=5.238; P=0.061), although the difference was not statistically significant.
A significant proportion of HBV-HCV-coinfected patients undergoing haemodialysis developed HBV reactivation after DAA therapy. The risk of HBV reactivation was greater in HBsAg+ patients than in those patients who were HBsAg- but anti-HBc+ or HBV DNA+.
越来越多的报告指出，接受直接抗病毒药物（DAA）治疗的HBV和HCV合并感染患者会出现HBV再激活。血液透析患者中HBV再激活的潜在风险也已被注意到。对于那些接受血液透析的终末期肾病合并感染患者，缺乏关于DAA治疗期间再激活风险的数据。
在中国的两个血液净化中心对178人进行筛查，找出HBV-HCV合并感染患者，这些患者每日接受索磷布韦（200mg）联合达卡他韦（60mg）治疗。对DAA治疗期间HBV再激活的风险和模式进行回顾性分析。
在接受血液透析的HBV-HCV合并感染患者中，45.5%（5/11）在DAA治疗期间出现了HBV再激活，这远高于报道的合并感染患者总体发生率。5例出现HBV再激活的患者在DAA治疗前乙肝表面抗原（HBsAg）均为阳性。3例患者（27.3%）因HBV再激活出现轻度肝炎发作，但没有患者出现严重肝炎或肝衰竭。与基线时HBsAg阴性的4例患者相比，HBsAg阳性患者HBV再激活的风险更高（71.4%对0；χ=5.238；P=0.061），尽管差异无统计学意义。
相当一部分接受血液透析的HBV-HCV合并感染患者在DAA治疗后出现了HBV再激活。HBsAg阳性患者HBV再激活的风险高于HBsAg阴性但抗-HBc阳性或HBV DNA阳性的患者。
