Management Of Patients With Hepatitis B Virus Reactivation Post–DAA Treatment Of Chronic Hepatitis C Virus Infection In HCV–HBV Coinfected Patients With Pretreatment HBeAg Seroconversion And Early Degree Of Hepatic Fibrosis
Received 16 May 2019
Accepted for publication 27 August 2019
Published 30 September 2019 Volume 2019:12 Pages 3067—3073
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Joachim Wink
Heba Ahmed Osman,1 Ali A Ghweil,1 Abeer MM Sabry,2 Reem E Mahdy,3 Ashraf Khodeary4
1Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Egypt; 2Internal Medicine and Gastroenterology Department, Faculty of Medicine, Helwan University, Helwan, Egypt; 3Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Clinical Pathology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
Correspondence: Heba Ahmed Osman
Lecturer of Tropical Medicine and Gastroenterology Department, Faculty of Medicine, South Valley University, Qena, Qena 83523, Egypt
Tel +20 96 10 656 4745
Background and aim: Hepatitis C virus (HCV)–HBV coinfection is a significant health problem with rapid progression of liver disease without precise diagnosis and treatment. We aimed in this study to identify if there were any role of HBV antiviral therapy in patients with HBV reactivation after direct-acting antiviral therapy in HCV–HBV coinfected patients.
Methods: A prospective random study was carried out on 140 patients presenting with chronic HCV and chronic HBV coinfection. All patients had pretreatment HBeAg seroconversion, HBV DNA <2,000 IU/mL, normal liver enzymes, and F0/F1 hepatic fibrosis. They treated with sofosbuvir 400 mg and daklatasvir 60 mg once daily for 3 months. All patients underwent pretreatment hepatic fibrosis assessment using Fibro Scan and laboratory investigations: platelet count, liver-function tests, quantitative HCV PCR, HBsAg, HBc IgG, HBeAg, and HBeAb. All patients were followed up at 1, 3, 6, and 12 months from the start of HCV therapy.
Results: The study enrolled 140 HCV–HBV coinfected patients: 55% were F0 and the rest F1. All our patients had negative HCV PCR at 1 month posttreatment and had achieved sustained virologic response with negative HCV PCR 3 months after treatment end. Four patients showed HBV reactivation with raised HBV DNA PCR and liver enzymes. Their mean age was 23.7±2.7 years, and three were male. Regarding patients with HBV reactivation, at 12 months posttreatment they showed significant decreases in liver enzymes, bilirubin, and INR, with increased platelet count (P=0.001), each with undetectable HBV PCR (P=0.001).
Conclusion: HBV–HCV coinfected patients with no/mild hepatic fibrosis, HBeAg seroconversion, and HBV DNA <2,000 IU/mL can complete direct-acting antiviral therapy without HBV antiviral treatment with close monitoring.
Keywords: HBV, HCV, PCR, DAAs
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