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Background Hepatitis B virus (HBV) may reactivate when treating chronic hepatitis C (CHC) with direct-acting antivirals (DAA). We aimed to investigate the risk of HBV infection and reactivation during DAA therapy by performing a prospective observational study carried on 200 patients positive for chronic HCV who were candidates for treatment by DAA therapy according to the Egyptian guidelines from February 2019 to December 2019; the patients identified to carry HBsAg at baseline or with positive HBc Abs were further assessed for other HBV markers: hepatitis B e antigen at baseline, and serum HBV DNA quantitative measurement at baseline, week 4 of treatment, end of treatment. On the other hand, recent infection by HBV among those patients was observed. Results Of all participants, 49% were males and 51% were females, aged above 18 years. There is a highly statistically significant difference (p-value < 0.05) between HCV RNA PCR (at the beginning, at the end of 4 weeks, and at the end of 12 weeks) in studied patients. There was a highly statistically significant difference found between the liver function tests at the beginning, at the end of 4 weeks, and at the end of 12 weeks of treatment where it shows improvement except for serum albumin. At beginning of the study, there were 34 patients who are co-infected with HCV and HBV with quantitative PCR test for HBV DNA ≥ 20 IU/ml. After 1 month of DAA therapy, reactivation was detected in 6 cases (4 occult cases show reverse seroconversion (became HBs Ag positive), and 2 co-infected cases show increased HBV DNA > 1000 IU/L above the baseline level). In addition, 3 new cases acquired recent infection with the positivity of HBc IgM and detectable levels of HBV DNA. After 3 months of study, reactivation was detected in one patient with co-infection (where increased HBV DNA > 1000 IU/L above the baseline level), and 5 new cases acquired recent infection late in the study. Conclusion Screening for HBV infection prior to DAA therapy is required to detect recent infection of reactivation of previous infection during or after DAA therapy.

Background: Approximately one-third of the world's population is exposed to hepatitis B virus infection, where 400 million are chronically infected. Approximately 25% of those infections are at risk for mortality due to chronic liver disease or hepatocellular carcinoma (HCC). In Egypt, the population prevalence rate for HBV is 1.4% in adults aged 15-59 years old mainly higher in Upper Egypt (Aswan, Assiut, and Minya Governorates). Objective: Our study aims to demonstrate the prevalence of occult hepatitis B virus infection (OBI) among a randomly selected sample of Assiut University students, Egypt. Patients and Methods: A cross-sectional study was conducted in the period between April 2019 and September 2019, and included 200 students, aged 17 to 27 years old. They were randomly selected during the routine checkup and enrolled in the study for biological testing of HBV. Results: Prevalence of occult hepatitis B infection in all students reached 1.5% (2 males and one female). There was no significant difference between the mean age of OBI students compared to the mean age of OBI negative students (p = 0.133). There was a highly significant difference between the mean of HBV DNA PCR +ve students and the mean of HBV DNA PCR in -ve ones (p <0.001). The prevalence of the core antibody in OBI students was -ve ( 100% ). There was a highly significant difference between the mean of ALT in OBI students and the mean of ALT of negative ones (p <0.001). Risk factors associated with OBI students in this study included the use of shaving blades, barber visits, sharing shaving blades, dental visits, sharing nail clippers and, surgery. Conclusion:The prevalence of occult hepatitis B virus infection among students at Assiut University, was 1.5%.

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