DAA Treatment Linked to HBV Recurrence in HepC Patients

Individuals with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection who are treated with direct-acting antiviral (DAA) therapy have an increased risk for HBV reactivation, according to a recent systematic review and meta-analysis. However, this risk is much lower in patients with resolved HBV infection.

For their review, the researchers identified and evaluated 1621 patients with chronic (n = 242) or resolved (n = 1379) HBV infection enrolled in 17 studies who had been treated with different DAAs.
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Study data from October 1, 2010, to September 30, 2017, were obtained from PubMed, Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, and Web of Science. Random-effects models were used to pool data.

HBV reactivation occurred in 24% of patients with chronic HBV infection compared with 1.4% of patients with resolved HBV infection. Approximately 9% patients had HBV-reactivation-related hepatitis, and a significantly lower relative risk (RR) of HBV-reactivation-related hepatitis was observed in patients with HBV DNA of less than the lower limit of quantification at baseline vs patients with quantifiable HBV DNA (RR 0.17).

Three major clinical events that were associated with HBV reactivation in patients with chronic HBV infection were reported (1 patient had liver decompensation and 2 patients had liver failure, of which 1 required liver transplantation). However, no HBV-reactivation-related hepatitis was reported in patients with resolved HBV infection.

“HBV reactivation occurs frequently in patients with chronic HBV and HCV coinfection receiving DAA therapy but is rare among patients with resolved HBV infection,” the researchers concluded. “Use of antiviral prophylaxis might be warranted in patients who test positive for hepatitis B surface antigen (HBsAg), particularly those with quantifiable HBV DNA.”

—Christina Vogt

Reference:

Mücke MM, Backus LI, Mücke VT, et al. Hepatitis B virus reactivation during direct-acting antiviral therapy for hepatitis C: a systematic review and meta-analysis [Published online January 19, 2018]. Lancet Gastroenterol Hepatol. http://dx.doi.org/10.1016/S2468-1253(18)30002-5.