The Predictive Role of Hepatitis B Biomarkers on HBV Reactivation following Direct-Acting Antiviral Therapy in HBV/HCV Coinfected Patients

Abstract

Hepatitis B and C (HBV/HCV) coinfected patients have a potential risk of hepatitis B reactivation (HBVr) after direct-acting antivirals (DAAs) treatment. The study intends to investigate the predictive role of HBV biomarkers in HBVr. Forty-six HBV/HCV coinfected patients receiving DAAs were enrolled. All patients completed treatment and follow-up to the 12th-week post-DAA treatment (P12). Blood samples were measured for HBV biomarkers, including hepatitis B surface antigen (HBsAg), hepatitis B core-related antigen (HBcrAg), and HBV pregenomic RNA (HBV pgRNA). The predictive factors for HBVr after DAA treatment were analyzed. Among 31 patients without nucleot(s)ide analogue (NA) treatment, seven (22.5%, 7/31) developed HBVr without hepatitis flare-up. Patients with HBVr had higher HBsAg titers than those without HBVr from baseline to P12 (p = 0.008, 0.009, 0.004, and 0.006 at baseline, week 4, end of treatment, and P12, respectively). The baseline HBsAg level was the only predictive factor associated with HBVr (HR, 2.303; 95% CI, 1.086–4.882; p = 0.030). In predicting HBVr, a baseline HBsAg titer > 20 IU/mL had a sensitivity, specificity, positive predictive value, and negative predictive value of 85.7%, 75.0%, 50%, and 94.7%, respectively. No patient had HBVr if the baseline HBsAg titer was <8 IU/mL. Serum HBcrAg and HBV pgRNA levels had no role in predicting HBVr. In conclusion, HBV/HCV coinfected patients are at risk of HBVr after DAA treatment. The baseline HBsAg level was the predictive factor associated with HBVr. Patients with a baseline HBsAg titer < 8 IU/mL can be considered as not having HBVr.

Oncostatin M Induces IFITM1 Expression to Inhibit Hepatitis B Virus Replication Via JAK-STAT Signaling

“…cccDNA is the stable form of HBV DNA within the nucleus, and HBV pgRNA and HBcAg are identified as ideal biomarkers reflecting HBV genome transcription activity. 18 We then investigated the intracellular HBV RNAs and antigens levels after OSM treatment. OSM treatment led to significantly decreased levels of HBV transcripts (pgRNA and total RNA) and of viral antigens (HBsAg and HBcAg) ( Figure 2 D and E ).…”

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

“…The profiles of serum cytokines/chemokines may be useful for the prediction of HBV reactivation [ 77 , 118 , 119 ]. Among patients coinfected with HBV and HCV, the baseline HBsAg level was also the predictive factor associated with HBV reactivation following DAA treatment [ 120 ]. In the DAA treatment for HCV acute exacerbation, attention should be paid to HBV reactivation.…”

Hepatitis C virus/Hepatitis B virus coinfection: Current prospectives

“…The patient did not have HBV if the baseline HBsAg titre was less than 8 IU/ml. 104 Another study compared the blood levels of cytokines and chemokines in 25 patients with HCV/HBV coinfection before and after DAA therapy. Twenty individuals exhibited considerable virologic reactivation, compared to six patients who had minor clinical reactivation.…”

“…Its presence indicates active HBV infection. 104 An increase or reappearance of HBsAg levels may suggest HBV reactivation. HBeAg is another viral protein that indicates active viral replication.…”