Alberto, S

Alexandrino, G

Carvalho, R

Costa, M

Figueiredo, L

Martins, A

English

Repositório do Hospital Prof. Doutor Fernando Fonseca

Reactivation of hepatitis B virus infection during treatment of hepatitis C with direct-acting antivirals Figueiredo LM; Alexandrino G; Costa M; Carvalho R; Alberto S; Martins A Gastroenterology Department – Hospital Professor Doutor Fernando Fonseca – Lisbon, Portugal INTRODUCTION METHODOLOGY RESULTS CONCLUSIONS Reactivation of hepatitis B virus infection (HBV) can occur during treatment of hepatitis C with direct-acting antivirals (DAAs). Although it was also reported in the IFN “era”, with similar  incidence  rates, it seems to occur much earlier with DAAs. It has been almost exclusively described in the cases of positive AgHbs and in no case of positive anti-HBs. The risk in cases of isolated anti-HBc positive (anti-HBcPI) is minimal and its surveillance is not well defined. The aim of this study is to investigate the risk of reactivation of HBV during treatment with DAAs in anti-HBcPI patients.  REFERENCES 1- Monte A, et al Direct acting antiviral treatment in adults infected with hepatitis C virus: reactivation of hepatitis B virus coinfection as a further challenge Journal of Clinical Virology 78(2016)27–30; 2- Chen G,  et al Hepatitis B reactivation in hepatitis B and C coinfected patients treated with antiviral agents: A systematic review and meta-analysis. Hepatology. 2017 Jul;66(1):13-26; 3- Belperio PS, et al Evaluation of Hepatitis B Reactivation among 62,920 Veterans treated with Oral Hepatitis C Antivirals Hepatology. 2017 Jul;66(1):27-36. HBV infection was identified  In 125 patients  329 chronic hepatitis C patients treated with DAAs Prospective study in a cohort of 329 chronic hepatitis C patients treated with DAAs from February 2015 to March 2017.  Virological reassessment of HBV infection was performed in the 12 and 24 week posttreatment period.  We considered The European Association for the Study of the Liver definitions of HBV reactivation: DNA detectable HBV with or without elevated transaminases and increased HBV DNA> = 1 log10 in cases of positive DNA initially. There is a potential risk of HBV reactivation in HBV/HCV co-infected patients during treatment with DAAs for positive AgHBs cases, and the established guidelines should be followed.  In anti-HBcPI the risk of reactivation is practically nil. The frequency of surveillance of these patients remains to be defined, but probably after one undetectable DNA at SVR12, there will be no need for future reassessments. Disclosure- No conflicts of interest.   .   125: HBV infection 2: AgHBs + 1 started treatment 123: AgHBs- Anti-HBc+ 55 Anti-HBs + 68 Anti-HBs - 92%   Anti-HBcPI: 91,2% Anti-HBcPI F4: 89,3% Anti-HBcPI non F4: 92,5% Sustained Virologic Response (SVR12) In this cohort, past HBV infection with anti-HBcPI was prevalent (21%).  All cases of SVR12 maintained normal transaminases at follow up. None of these patients had biochemical or virological reactivation at short-term follow-up. Undetectable DNA Anti-HBcPI 

Reactivation of hepatitis B virus infection during treatment of hepatitis C with  direct-acting antivirals

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Reactivation of hepatitis B virus infection during treatment of hepatitis C with direct-acting antivirals

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Repositório do Hospital Prof. Doutor Fernando Fonseca