Wang Mei, Wang Yi, Yang Zhigang, Yang Changming, Wang Jing, Xiong Huagang
Department of Hepatology, Guiyang Public Health Clinical Center, Guiyang, China.
Laboratory Department, Guiyang Public Health Clinical Center, Guiyang, China.
J Viral Hepat. 2025 Sep;32(9):e70061. doi: 10.1111/jvh.70061.
The objective of this study is to analyse the prevalence and clinical characteristics of HCV/HBV coinfection in Guizhou, and evaluate the rate of HBV reactivation during and after anti-HCV treatment in a real-world study. This retrospective study included 1652 patients with hepatitis C virus (HCV) infection who received direct-acting antiviral (DAA) therapy at the Guiyang Public Health Clinical Center between January 2018 and December 2022 Baseline, on-treatment and posttreatment data were collected, including HCV RNA, HCV genotypes, liver function, hepatitis B virus (HBV) markers (HBsAg, HBcAb) and HBV DNA levels. The HCV/HBV coinfection rate was analysed, and the risk of HBV reactivation and disease progression following DAA therapy was assessed. Among the 1652 HCV-infected patients, the HCV/HBV coinfection rate was 49.88% (824/1652). Of these, 5.08% (84/1652) were HBsAg-positive, while 44.79% (740/1652) were HBsAg-negative/HBcAb-positive with HBV DNA < 20 IU/mL. Compared to patients with HCV monoinfection, HBsAg-positive patients had a higher proportion of males, compensated and decompensated cirrhosis, hepatocellular carcinoma (HCC) and lower platelet (PLT) counts (χ = 15.482, 46.101; F = 7.292; all p < 0.05). Differences in HCV genotype distribution were observed among various HBV immune status groups (χ = 32.529, p < 0.05). The cumulative incidence of HBV reactivation in HCV/HBV coinfected patients treated with DAAs was 1.2% (10/824). Among these, the reactivation rate was 16.67% (9/54) in HBsAg-positive patients without prophylactic anti-HBV therapy and 0.1% (1/740) in HBsAg-negative/HBcAb-positive patients. Baseline HBsAg levels were significantly higher in patients with HBV reactivation than in those without reactivation (Z = -4.291, p < 0.05). No significant changes were observed in liver function or PLT levels after HBV reactivation compared to baseline (p > 0.05), and no cases of liver failure were reported. In Guizhou, a relatively high prevalence of HBsAg-positivity and a large proportion of past HBV exposure (HBsAg-negative/HBcAb-positive, HBV DNA < 20 IU/mL) were observed among HCV-infected patients. While HBV reactivation can occur in HCV/HBV coinfected patients undergoing DAA therapy, the overall risk is low. A baseline HBsAg level > 185 IU/mL is a significant risk factor for HBV reactivation.
本研究的目的是分析贵州地区丙型肝炎病毒（HCV）/乙型肝炎病毒（HBV）合并感染的患病率及临床特征，并在一项真实世界研究中评估抗HCV治疗期间及治疗后HBV再激活的发生率。这项回顾性研究纳入了2018年1月至2022年12月期间在贵阳市公共卫生临床中心接受直接抗病毒药物（DAA）治疗的1652例丙型肝炎病毒感染患者。收集了基线、治疗期间和治疗后的资料，包括HCV RNA、HCV基因型、肝功能、乙型肝炎病毒标志物（HBsAg、HBcAb）及HBV DNA水平。分析了HCV/HBV合并感染率，并评估了DAA治疗后HBV再激活和疾病进展的风险。在1652例HCV感染患者中，HCV/HBV合并感染率为49.88%（824/1652）。其中，5.08%（84/1652）为HBsAg阳性，44.79%（740/1652）为HBsAg阴性/HBcAb阳性且HBV DNA＜20 IU/mL。与HCV单一感染患者相比，HBsAg阳性患者中男性、代偿期和失代偿期肝硬化、肝细胞癌（HCC）的比例更高，血小板（PLT）计数更低（χ=15.482, 46.101；F=7.292；均p＜0.05）。不同HBV免疫状态组间HCV基因型分布存在差异（χ=32.529, p＜0.05）。接受DAA治疗的HCV/HBV合并感染患者中HBV再激活的累积发生率为1.2%（10/824）。其中，未接受预防性抗HBV治疗的HBsAg阳性患者再激活率为16.67%（9/54），HBsAg阴性/HBcAb阳性患者为0.1%（1/740）。发生HBV再激活的患者基线HBsAg水平显著高于未发生再激活的患者（Z=-4.291, p＜0.05）。与基线相比，HBV再激活后肝功能和PLT水平未见显著变化（p＞0.05），且未报告肝衰竭病例。在贵州，HCV感染患者中观察到相对较高的HBsAg阳性患病率以及很大比例的既往HBV暴露（HBsAg阴性/HBcAb阳性，HBV DNA＜20 IU/mL）。虽然接受DAA治疗的HCV/HBV合并感染患者可能发生HBV再激活，但总体风险较低。基线HBsAg水平＞185 IU/mL是HBV再激活的重要危险因素。
