Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Viral Hepat. 2021 May;28(5):844-848. doi: 10.1111/jvh.13478. Epub 2021 Feb 10.
Direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection can cause hepatitis B virus (HBV) reactivation in HBV/HCV co-infected patients. Cancer patients undergoing immunosuppressant treatment or chemotherapy are at risk for HBV reactivation. To our knowledge, no prospective studies have examined the risk of HBV reactivation during DAA treatment for HCV infection in cancer patients with HBV/HCV co-infection. Here, we report the results of one such study. In a prospective observational study, we enrolled HCV-infected cancer patients undergoing DAA treatment at The University of Texas MD Anderson Cancer Center between January 2015 and March 2018. Data regarding demographics, cancer history, and prior HCV treatment history were collected. Patients were assessed for HBV status before DAA treatment and for HBV-related outcomes, including HBV reactivation, hepatitis flare, and HBV-associated hepatitis, during DAA treatment. Demographic and treatment variables were analyzed using descriptive statistics. One hundred sixty-six patients were analyzed. Forty-eight patients received systemic chemotherapy within 6 months before to 6 months after treatment with DAAs. Ledipasvir plus sofosbuvir was the most common DAA regimen, administered to 88 patients (53%). Fifty-one patients (31%) had past HBV infection, and 4 (2.4%) had chronic HBV infection. No patient experienced HBV reactivation, hepatitis flare, or HBV-associated hepatitis induced by DAA treatment. In HCV-infected cancer patients, DAA treatment is safe regardless of whether patients have past or chronic HBV infection. However, HBV screening is still recommended before the initiation of and during DAA treatment, as is anti-HBV prophylactic treatment in selected cases.
直接作用抗病毒药物（DAAs）可治疗丙型肝炎病毒（HCV）感染，但会导致乙型肝炎病毒（HBV）在 HBV/HCV 合并感染者中再激活。接受免疫抑制剂治疗或化疗的癌症患者存在 HBV 再激活的风险。据我们所知，尚无前瞻性研究探讨合并 HBV/HCV 感染的癌症患者在接受 DAA 治疗 HCV 感染期间发生 HBV 再激活的风险。在此，我们报告了其中一项研究的结果。在一项前瞻性观察性研究中，我们纳入了 2015 年 1 月至 2018 年 3 月期间在德克萨斯大学 MD 安德森癌症中心接受 DAA 治疗的 HCV 感染癌症患者。收集了有关人口统计学、癌症史和既往 HCV 治疗史的数据。在接受 DAA 治疗之前评估患者的 HBV 状态，并在 DAA 治疗期间评估 HBV 相关结局，包括 HBV 再激活、肝炎发作和 HBV 相关性肝炎。采用描述性统计分析人口统计学和治疗变量。共分析了 166 例患者。48 例患者在接受 DAA 治疗前 6 个月内至治疗后 6 个月内接受了全身化疗。雷迪帕韦加索磷布韦是最常用的 DAA 方案，有 88 例（53%）患者接受了该方案。51 例（31%）患者既往有 HBV 感染，4 例（2.4%）患者患有慢性 HBV 感染。没有患者因 DAA 治疗发生 HBV 再激活、肝炎发作或 HBV 相关性肝炎。在 HCV 感染的癌症患者中，无论患者既往或慢性 HBV 感染，DAA 治疗都是安全的。然而，在开始 DAA 治疗之前和治疗期间仍推荐进行 HBV 筛查，在某些情况下还需进行抗 HBV 预防性治疗。
