Tseng Chih-Wei, Liu Wen-Chun, Ko Ping-Hung, Chen Yen-Chun, Tseng Kuo-Chih, Chang Ting-Tsung
Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan.
School of Medicine, Tzuchi University, Hualien 97004, Taiwan.
Viruses. 2022 Aug 18;14(8):1812. doi: 10.3390/v14081812.
Hepatitis B and C (HBV/HCV) coinfected patients have a potential risk of hepatitis B reactivation (HBVr) after direct-acting antivirals (DAAs) treatment. The study intends to investigate the predictive role of HBV biomarkers in HBVr. Forty-six HBV/HCV coinfected patients receiving DAAs were enrolled. All patients completed treatment and follow-up to the 12th-week post-DAA treatment (P12). Blood samples were measured for HBV biomarkers, including hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg), and HBV pregenomic RNA (HBV pgRNA). The predictive factors for HBVr after DAA treatment were analyzed. Among 31 patients without nucleot(s)ide analogue (NA) treatment, seven (22.5%, 7/31) developed HBVr without hepatitis flare-up. Patients with HBVr had higher HBsAg titers than those without HBVr from baseline to P12 (p = 0.008, 0.009, 0.004, and 0.006 at baseline, week 4, end of treatment, and P12, respectively). The baseline HBsAg level was the only predictive factor associated with HBVr (HR, 2.303; 95% CI, 1.086−4.882; p = 0.030). In predicting HBVr, a baseline HBsAg titer > 20 IU/mL had a sensitivity, specificity, positive predictive value, and negative predictive value of 85.7%, 75.0%, 50%, and 94.7%, respectively. No patient had HBVr if the baseline HBsAg titer was <8 IU/mL. Serum HBcrAg and HBV pgRNA levels had no role in predicting HBVr. In conclusion, HBV/HCV coinfected patients are at risk of HBVr after DAA treatment. The baseline HBsAg level was the predictive factor associated with HBVr. Patients with a baseline HBsAg titer < 8 IU/mL can be considered as not having HBVr.
乙肝和丙肝（HBV/HCV）合并感染患者在接受直接抗病毒药物（DAA）治疗后有乙肝再激活（HBVr）的潜在风险。本研究旨在调查乙肝生物标志物在HBVr中的预测作用。纳入了46例接受DAA治疗的HBV/HCV合并感染患者。所有患者均完成治疗并随访至DAA治疗后第12周（P12）。检测血样中的乙肝生物标志物，包括乙肝表面抗原（HBsAg）、乙肝核心相关抗原（HBcrAg）和乙肝前基因组RNA（HBV pgRNA）。分析DAA治疗后HBVr的预测因素。在31例未接受核苷（酸）类似物（NA）治疗的患者中，7例（22.5%，7/31）发生HBVr且无肝炎发作。从基线到P12，发生HBVr的患者的HBsAg滴度高于未发生HBVr的患者（基线、第4周、治疗结束时和P12时的p值分别为0.008、0.009、0.004和0.006）。基线HBsAg水平是与HBVr相关的唯一预测因素（HR，2.303；95%CI，1.086−4.882；p = 0.030）。在预测HBVr时，基线HBsAg滴度>20 IU/mL的灵敏度、特异度、阳性预测值和阴性预测值分别为85.7%、75.0%、50%和94.7%。如果基线HBsAg滴度<8 IU/mL，则无患者发生HBVr。血清HBcrAg和HBV pgRNA水平在预测HBVr中无作用。总之，HBV/HCV合并感染患者在DAA治疗后有HBVr风险。基线HBsAg水平是与HBVr相关的预测因素。基线HBsAg滴度<8 IU/mL的患者可被视为不会发生HBVr。
