Department of Infectious Diseases and Hepatology, Medical University of Silesia , Katowice, Poland.
Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University , Poland.
Expert Rev Anti Infect Ther. 2020 Oct;18(10):1045-1054. doi: 10.1080/14787210.2020.1782189. Epub 2020 Jun 27.
The aim of the study was to analyze the prevalence and clinical characteristics of HCV/HBV coinfection and to evaluate the rate of HBV-reactivation during anti-HCV therapy in a large real-world study.
Analyzed population consisted of 10,152 chronic hepatitis C patients treated with DAA between 2015 and 2019 in a nationwide study. Prior to the DAA all subjects had HBsAg and 60% anti-HBc testing.
111 of 10,152 patients (1.1%) had detectable HBsAg and 1239 of 6139 (20.2%) anti-HBcAb. The prevalence of occult hepatitis B was 0.48%. HCV/HBV patients were younger with a higher proportion of males, HIV-coinfected, and advanced fibrosis. They were less often diagnosed with diabetes but more often with chronic kidney disease. In HBsAg(+) subjects with baseline HBV-DNA available 6/102 (5.9%) HBV-reactivations during or after DAA therapy were observed, and in two (1.9%) significant hepatic flares were noted. In HBsAg(-)/anti-HBc(+) group 2 (0.16%) reactivations were observed only in patients undergoing immunosuppressive therapy.
Data from a large European cohort suggest a relatively low risk of HBV-reactivation during DAA-therapy for HCV infection in HBsAg(+) patients. In HBsAg(-)/anti-HBc(+) HBV-reactivation seems to be limited to subjects with immunodeficiency. Importantly, previous exposure to HBV and occult hepatitis B is present in a significant proportion of HCV-infected.
本研究旨在分析 HCV/HBV 合并感染的流行率和临床特征，并在一项大型真实世界研究中评估抗 HCV 治疗期间 HBV 再激活的发生率。
分析人群由 2015 年至 2019 年间接受 DAA 治疗的 10152 例慢性丙型肝炎患者组成。在开始 DAA 治疗前，所有患者均进行了 HBsAg 和 60%抗 HBc 检测。
10152 例患者中 111 例（1.1%）可检测到 HBsAg，6139 例（20.2%）抗 HBcAb 阳性。隐匿性乙型肝炎的患病率为 0.48%。HCV/HBV 合并感染患者更年轻，男性比例更高，HIV 合并感染，且纤维化程度更高。他们诊断为糖尿病的比例较低，但慢性肾脏病的比例较高。在 HBsAg(+)且基线 HBV-DNA 可检测的患者中，6/102（5.9%）例在 DAA 治疗期间或之后观察到 HBV 再激活，其中 2 例（1.9%）出现明显的肝衰竭。在 HBsAg(-)/抗 HBc(+)组中，仅在接受免疫抑制治疗的患者中观察到 2（0.16%）例再激活。
来自大型欧洲队列的数据表明，在 HBsAg(+)患者中，DAA 治疗 HCV 感染时 HBV 再激活的风险相对较低。在 HBsAg(-)/抗 HBc(+)患者中，HBV 再激活似乎仅限于免疫缺陷患者。重要的是，以前暴露于 HBV 和隐匿性乙型肝炎在很大一部分 HCV 感染患者中存在。
