Fulminant hepatitis B reactivation leading to liver transplantation in a patient with chronic hepatitis C treated with simeprevir and sofosbuvir: a case report

Abstract

IntroductionHepatitis B and C coinfection is commonly seen in clinical practice. In coinfected individuals, high levels of hepatitis C viremia are often associated with low levels of serum hepatitis B DNA. Hepatitis B reactivation in hepatitis C-infected patients treated with pegylated interferon and ribavirin has been reported, but severe or fulminant reactivation is uncommon. Hepatitis C treatment-associated hepatitis B reactivation in patients with chronic hepatitis C and isolated core antibody has not been reported previously.Case presentationA 59-year-old white woman with chronic hepatitis C genotype 1B and isolated hepatitis B core antibody initiated treatment with simeprevir, sofosbuvir, and ribavirin for treatment of chronic hepatitis C. She responded very well to treatment initially with near normalization of aminotransferases and hepatitis C viral load suppressed to below the level of quantification after 4 weeks of treatment. At week 11 of a planned 12-week course, she developed fulminant hepatic failure due to hepatitis B reactivation and ultimately required liver transplantation. Fortunately, her posttransplant clinical course was unremarkable.ConclusionsThis is the first report of hepatitis B reactivation in a patient with isolated hepatitis B core antibody leading to fulminant hepatic failure and liver transplantation after initiation of treatment with sofosbuvir, simeprevir, and ribavirin for hepatitis C. This case raises the concern for the risk of severe hepatitis B reactivation in hepatitis B and C-coinfected patients or chronic hepatitis C-infected patients with isolated hepatitis B core antibody treated with direct-acting antiviral drugs for hepatitis C.

Reactivation of Hepatitis B Virus During Treatment of Hepatitis C Genotype 3 with Daclatasvir and Sofosbuvir in a Patient with Dual Infection of Hepatitis B and Hepatitis C Virus

“…Finally, similar three other cases of HBV reactivation were reported during HCV treatment with DAAs (sofosbuvir/simeprevir) in patients with HBV and HCV genotype 1 coinfections (17,18). These three patients had a history of past treatment of their HCV infection with peginterferon/ribavirin without virological response.…”

EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection

“…They identified 24 cases of HBV reactivation in HCV/HBV coinfected patients treated with DAAs during a 31-month period from November 2013 to July 2016. [174][175][176][177] More recent data confirms the risk of HBV reactivation associated with DAA therapy. In one publication, out of 103 patients with evidence of previous HBV exposure (HBsAg-negative, anti-HBc positive) undergoing DAA therapy, none experienced reactivation.…”

Risk of HBV Reactivation in Patients Infected with HBV/HCV Treated with DAA

“…The first report of hepatitis B reactivation leading to fulminant hepatic failure and liver transplantation after initiation of IFN-free treatment for hepatitis C was described by Ende et al (10). The case concerned a 59-yearold woman with chronic hepatitis C genotype 1b and isolated anti-HBc serum presence, who initiated treatment with simeprevir, sofosbuvir, and ribavirin.…”

“…It was the basis for the hypothesis that there are reciprocal interactions between HBV and HCV, where HBV replication is inhibited by HCV (10).…”

“…In real-life treatment, some causes of HBV reactivation during treatment with various DAA regimens, including simeprevir plus sofosbuvir (with or without ribavirin), daclatasvir plus asunaprevir, and ledipasvir/sofosbuvir were described (10,(18)(19)(20).…”