Hepatitis due to Reactivation of Hepatitis B Virus in Endemic Areas Among Patients With Hepatitis C Treated With Direct-acting Antiviral Agents

Wang, Cheng; Ji, Dong; Chen, Jing; Shao, Qing; Li, Bing; Li, Jialiang; Wu, Vanessa; Wong, Allen; Wang, Yudong; Zhang, Xiaoyong; Lü, Ling; Wong, Chris L. P.; Tsang, Stella; Zhang, Zheng; Sun, Jian; Hou, Jilun; Chen, Guofeng; Lau, George

doi:10.1016/j.cgh.2016.06.023

Cited by 167 publications

(196 citation statements)

References 19 publications

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“…Twelve patients infected with HBV and HCV were observed, and no cases showed deinitive HBV reactivation during or after DAA treatment. Wang et al reported that of 317 patients enrolled, 3 of the 10 patients with HBsAg showed HBV reactivation [18]. However, another study reported no evidence of HBV reactivation among patients treated with ledipasvir-sofosbuvir [19].…”

Section: Discussionmentioning

confidence: 98%

“…HBV reactivation thus remains controversial. Wang et al speculated that DAAs, particularly NS3 polymerase inhibitors, carry a high risk of HBV reactivation because most reports of HBV reactivation related to DAA involved NS3 polymerase inhibitors [13,14,16,18]. Ledipasvir is a NS5A replication complex inhibitor, and sofosbuvir is a NS5B polymerase inhibitor.…”

Section: Discussionmentioning

confidence: 99%

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Impact of HBV Infection on Outcomes of Direct-Acting Antiviral Therapy of Chronic Hepatitis C

Hayashi¹,

Ishigami²,

Ishizu³

et al. 2017

Update on Hepatitis C

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Background: Most clinical trials of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection have excluded hepatitis B virus (HBV) coinfection, and litle is known about the efects of DAA on chronic hepatitis C patients with HBV coinfection.Recent studies have reported that DAA therapy for HCV can also cause HBV reactivation in patients with HBV and HCV coinfection. The aim of this study was to assess the efects of DAA on sustained virologic response (SVR) and HBV reactivation in patients with chronic hepatitis C. Methods: Participants comprised 199 chronic hepatitis C patients who received DAA therapy (96 men, 103 women; mean age, 66.7 ± 12.0 years). Results: Twelve patients were coinfected with HCV and HBV. Sixty patients were HBV surface antigen negative but positive for hepatitis B core antibody and/or hepatitis B surface antibody, and one hundred and twenty-seven patients had not been exposed to HBV. Rates of SVR in HBV and HCV coinfected patients, HBV prior infection, and no exposure to HBV were 100, 95, and 97%, respectively. Signiicant diferences were seen between each group. No case showed HBV reactivation. Conclusions: DAA treatments were efective in patients with HBV coinfection or HBV prior infection, as well as HCV monoinfection. As the number of cases was small, we still suggest caution regarding HBV reactivation in HCV and HBV coinfected patients undergoing treatment with DAA.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Impact of HBV Infection on Outcomes of Direct-Acting Antiviral Therapy of Chronic Hepatitis C

Hayashi¹,

Ishigami²,

Ishizu³

et al. 2017

Update on Hepatitis C

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“…A reactivation of HBV is thought to be a result of an immunological response to infected hepatocytes that replicate HBV after the restoration of both innate (restoration of NK cell phenotype and function) and adaptive (improvement in CD8+T cell function) immunological mechanisms with interferon treatment against CHC [22,23]. Spontaneous fluctuations in the HBV-DNA levels are common in patients with HBs Ag-positive.…”

Section: Discussionmentioning

confidence: 99%

Chronic Hepatitis B Reactivation Subsequent to Chronic Hepatitis C Treatment: A Case Report

Gedık¹,

Parcaoglu²

2017

J Hep

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Patients, who are coinfected with hepatitis B and C, are at high risk for a progression to severe liver disease (cirrhosis, decompensated liver disease), hepatocellular carcinoma, and unresponsiveness to treatment. In this article, a case who developed a reactivation of chronic hepatitis B subsequent to Chronic Hepatitis C (CHC) treatment is presented. A 42-year-old woman with HBV and HCV was admitted to infectious diseases clinic with a major complaint of fatigue for three months. Laboratory tests revealed an elevated alanine transaminase of 182 IU/L (Normal range: 0-55 IU/L), elevated aspartate transaminase of 150 IU/L, serum HCV-RNA levels of 2080195 IU/mL (genotype 1b), and HBV-DNA of 1184 IU/mL. The results of other laboratory tests were within the normal range and remained to be normal during the follow-up. Pegylated interferon alpha-2a (180 mcg/week) and ribavirin (1200 mg/day) were administered for the treatment of CHC for 48 weeks. After one year of CHC treatment, our case was admitted with the elevation in liver enzymes and HBV-DNA of 878215 IU/mL. The histopathological examination of liver tissue revealed a mildly active histologic activity (6/18) and a mildly active histological activity (1/6) according to ISHAK scoring. Tenofovir disoproxil tablet (245 mg/day) was initiated for the chronic hepatitis B treatment. The patient is followed up at the ambulatory clinic of infectious diseases. As a result, patients coinfected with HBV and HCV should be followed up for the reactivation of HBV after CHC treatment with either pegylated interferon-based therapy or oral direct-acting antiviral agents in the medium-term, and the cirrhosis and hepatocellular carcinoma in the long-term.

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“…The rates of HCV coinfection in HBsAg positive patients vary from 9 to 30%, depending on geographic region (4). In Yu et al study, 8.4% of patients with chronic HCV infection were co-infected with HBV (5).…”

Section: Contextmentioning

confidence: 99%

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

Pawłowska

Domagalski

2017

Hepat Mon

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The exact number of HBV/HCV co-infected patients is unknown. In many cases of HBV/HCV co-infection, HCV inhibits replication of HBV. After treatment and eradication of the dominant virus, the other one may then become active. The overall dominant effect appears to be hepatitis C over hepatitis B. Therefore, when planning treatment for eradication of HCV, the risk of HBV reactivation should be taken into account. In interferon-based therapies of patients with HBV/HCV co-infection, some cases of HBV reactivation without hepatitis were observed because IFN is effective against both viruses. In contrast, DAA treatment of hepatitis C in HBV/HCV co-infection is not well established. Currently, no clinical trials have been published regarding treatment of HBV/HCV co-infected patients with HCV DAA therapy. There is several research on HCV DAA therapy in HBV/HCV co-infection, which describes cases of HBV reactivation during and after DDA therapy for HCV. Result of the first available studies demonstrated that patients with HBV/HCV co-infection treated with DAA against HCV should be monitored for HBV reactivation during and after DAA treatment, even though HBV may be inactive at the time of treatment initiation.

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Hepatitis due to Reactivation of Hepatitis B Virus in Endemic Areas Among Patients With Hepatitis C Treated With Direct-acting Antiviral Agents

Cited by 167 publications

References 19 publications

Impact of HBV Infection on Outcomes of Direct-Acting Antiviral Therapy of Chronic Hepatitis C

Impact of HBV Infection on Outcomes of Direct-Acting Antiviral Therapy of Chronic Hepatitis C

Chronic Hepatitis B Reactivation Subsequent to Chronic Hepatitis C Treatment: A Case Report

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

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