Risk of hepatitis B reactivation in patients treated with direct-acting antivirals for hepatitis C.
Aggeletopoulou I, et al. World J Gastroenterol. 2017.
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The recent introduction of direct-acting antiviral drugs (DAAs) for treatment of the hepatitis C virus (HCV) has greatly improved the management of HCV for infected patients. These viral protein inhibitors act rapidly, allowing HCV clearance and increasing the sustained virological response rates. However, hepatitis B virus (HBV) reactivation has been reported in HCV/HBV co-infected patients. Hepatitis B reactivation refers to an abrupt increase in the HBV and is well-documented in patients with previously undetected HBV DNA due to inactive or resolved HBV infection. Reactivation can occur spontaneously, but in most cases, it is triggered by various factors. Reactivation can be transient, without clinical symptoms; however, it usually causes a hepatitis flare. HBV reactivation may occur regardless of HCV genotype and type of DAA regimen. HBV screening is strongly recommended for co-infected HCV/HBV patients before initiation and during DAA therapy regardless of HBV status, HCV genotype and class of DAAs used. HBV reactivation can be prevented with pretreatment screening and prophylactic treatment when necessary. Additional data are required to evaluate the underlying mechanisms of HBV reactivation in this setting.
PMID 28706414 [PubMed - in process] PMCID PMC5487495
I am on a couple of forums and so far haven’t see anyone report this happening to them. But of course it is a risk if you have a hep b infection
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In general, how common is reactivation of HBV infection?
RG If a person is infected with HCV, is placed on HCV treatment, and is HBsAg-positive, the risk of HBV reactivation is very high (probably 30%-50%). If the patient is HBsAg-negative but hepatitis B core antibody (anti-HBc)-positive, the risk of reactivation is probably between 1:1000 and 1:10,000, although a recent publication suggested that the risk might be even slightly higher. That estimate comes from data collection by the US Food and Drug Administration (FDA) and my expert estimate of the total US patient population treated to date with DAA agents.
G&H What are the most common risk factors for HBV reactivation?
RG If a patient is undergoing chemotherapy or immunosuppression and is HBsAg-positive, especially if he or she is HBV DNA–positive, the patient is at moderate to high risk of reactivation, especially if (1) a regimen containing rituximab is used; (2) the patient undergoes conditioning therapy for stem-cell transplantation; (3) the patient is being treated with a doxorubicin-based chemotherapy; and (4) high-dose prednisone is used for a prolonged period of time, typically in combination with other immunosuppression. In my practice, I follow the rule that 20 mg or more of prednisone per day for more than 20 days would place a patient at moderate to high risk of reactivation if the patient is HBsAg-positive.
In patients who are HBsAg-negative but anti-HBc–positive, the risk of reactivation is lower but not zero, and rituximab-containing regimens might pose a reactivation risk as high as 30% in anti-HBc–positive patients, as well as in the other 3 settings listed above. Thus, the risk of reactivation depends upon the patient’s serostatus and HBV DNA status. Approximately 7% of anti-HBc–positive patients who are HBsAg-negative have measurable HBV DNA at low levels and may be at higher risk of reactivation than patients who are HBV DNA–negative by sensitive polymerase chain reaction assays. A technical review and guidelines for HBV reactivation during immunosuppressive therapy were published in the January 2015 issue of Gastroenterology.