Hepatitis B reactivation in hepatitis B and C coinfected patients treated with antiviral agents: a systematic review and meta-analysis

Chen, G.F.; Wang, C.; Chen, J.; Ji, Dong; Shao, Quan; Li, F.; Li, B.; Wu, Vanessa; Wong, Allen; Wang, Y.D.; Lau, George

doi:10.1016/s0168-8278(17)30909-1

Cited by 14 publications

(20 citation statements)

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“…As with adults, testing for active HBV infection (i.e., HBsAg, anti‐HBc, and anti‐HBs) is recommended prior to initiating HCV DAA therapy in pediatric patients due to the risk for HBV reactivation during or after treatment . Additionally, on‐treatment and posttreatment glucose monitoring for hypoglycemia in children and adolescents with diabetes and INR monitoring in those taking warfarin is recommended due to potential alterations in dose–response relationships associated with DAA‐related HCV viral clearance …”

Section: Hcv In the Pediatric Populationmentioning

confidence: 99%

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

2020

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Section: Hcv In the Pediatric Populationmentioning

confidence: 99%

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

2020

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“…However, the majority of these cases of HBV reactivation were mild with regards to increases in HBV replication and also clinical presentation. A very recent systemic review and meta-analysis of HBV reactivation in HBV/HCV coinfected individuals found that the incidence was similar in DAA-based regimens (12.2%) and IFN-based regimens (14.5%) (144). However, clinical manifestations and timing of the HBV reactivation were starkly different.…”

Section: Hbv Reactivationmentioning

confidence: 99%

Hepatitis B reactivation during or after direct acting antiviral therapy – implication for susceptible individuals

Holmes

Chung

2017

Expert Opinion on Drug Safety

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Introduction The FDA issued a warning following 24 cases of HBV reactivation during DAA therapy for HCV, including individuals with inactive, occult and past HBV infection. Clinical presentations ranged from asymptomatic fluctuations in HBV DNA to fulminant hepatic failure, liver transplantation and death. The mechanism is unknown. Areas covered HCV/HBV coinfection is common, particularly in regions endemic for HBV. HCV and HBV utilize host factors to support replication; both viruses evade/impair host immunity. Clinical presentations of HBV reactivation during DAAs are summarized. Other causes of HBV reactivation are revisited and recent data regarding HBV reactivation are presented. Expert opinion HBV reactivation during DAAs for HCV occurs, with life-threatening consequences in some individuals. The risk of HBV reactivation is observed in all HBV stages. The rapid removal of HCV likely alters and liberates host-viral +/− viral-viral interactions that lead to increased HBV replication. As immune reconstitution occurs with HCV removal, host recognition of HBV DNA likely ensues followed by vigorous host immune responses leading to liver injury (HBV flare). These cases highlight the importance of HBV testing prior to initiating DAA therapy, the need for close monitoring of HBV during therapy and timely administration of anti-HBV therapy to prevent serious sequelae.

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“…Reactivation of HBV has been associated with direct‐acting antivirals (DAA) when treating HCV infection . MSM and PWUD are at high risk for both HBV and HCV infection, and seem to be less likely to clear HBV than other adult populations .…”

Section: Discussionmentioning

confidence: 99%

Frequent delayed spontaneous seroclearance of hepatitis B virus after incident HBV infection among adult high‐risk groups

Santen

Boyd

Bruisten

et al. 2019

Journal of Viral Hepatitis

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High rates (~25%) of developing chronic hepatitis B virus (HBV) infection (hepatitis B surface antigen (HBsAg)‐positive for > 6 months following infection) have been observed in people who use drugs (PWUD) and men who have sex with men (MSM). We aimed to estimate the frequency of delayed HBsAg seroclearance, along with its determinants, and time to delayed HBsAg seroclearance. Data were used from MSM and PWUD enrolled in the Amsterdam Cohort Studies (1985‐2002) who had anti‐hepatitis B core antibody seroconversion. Potential determinants for standard HBsAg seroclearance, delayed HBsAg seroclearance and chronic HBV were examined using multinominal logistic regression. Time to HBsAg seroclearance was estimated using Kaplan‐Meier curves. A total of 147 incident HBV infections occurred during follow‐up. On initial HBsAg testing after infection (6‐12 months), 42 (29%) were HBsAg‐positive and 105 (71%) were HBsAg‐negative (‘standard HBsAg seroclearance’). Of the 42 initially HBsAg‐positive individuals, 22 subsequently tested HBsAg‐negative (of whom 7 (31.8%) were HBV DNA positive at last visit, suggesting occult HBV). Overall, 15 became HBsAg‐negative and HBV DNA‐negative (‘delayed HBsAg seroclearance’), while 27 remained HBsAg and/or HBV DNA‐positive (‘chronic HBV’). The 5‐year cumulative probability of delayed HBsAg seroclearance was 41.6% for initially HBsAg‐positive individuals. Delayed HBsAg seroclearance and remaining chronically infected were associated with younger age and HIV/hepatitis C virus (HCV)‐co‐infection. In conclusion, delayed HBsAg seroclearance is common in these key adult populations at‐risk for HBV, while proportion developing HBV chronicity (18%) is still higher compared to the general population (~5%). Given the proportion of individuals with occult HBV infection and that HCV direct‐acting antivirals can lead to HBV reactivation, HBV DNA testing in HCV co‐infected MSM/PWUD are warranted prior to treatment initiation.

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Hepatitis B reactivation in hepatitis B and C coinfected patients treated with antiviral agents: a systematic review and meta-analysis

Cited by 14 publications

References 0 publications

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

Hepatitis B reactivation during or after direct acting antiviral therapy – implication for susceptible individuals

Frequent delayed spontaneous seroclearance of hepatitis B virus after incident HBV infection among adult high‐risk groups

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