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    HBV reactivation with direct acting antivirals for HCV is highly manageable


    Bersoff-Matcha and colleagues identified 29 unique case reports of HBV reactivation in patients receiving DAAs from November 22, 2013 to October 15, 2016. These patients with HBV reactivation were heterogeneous in regard to HCV genotype, DAAs received, and baseline HBV characteristics.

    Two-thirds of the patients were from Japan, and five patients were from the United States. The patients, an average age of about 61 years, were split about evenly between men and women. Of the 17 patients with HBV reactivation with a known HCV genotype, 15 patients had genotype 1 virus.

    Reactivation of HBV usually occurred four to eight weeks after initiation of DAA therapy. The average time from DAA start to HBV reaction was 53 days.

    At baseline, nine patients had a detectable HBV viral load, seven had positive results on hepatitis B surface antigen (HBsAg) testing and had an undetectable HBV viral load, and three had negative results on HBsAg testing and had an undetectable HBV viral load. Information was lacking for the remaining 10 patients.

    Despite provider knowledge of baseline HBV, HBV reactivation diagnosis and treatment were delayed in seven cases and possibly in seven others.

    Three patients with HBV reactions developed decompensated liver failure. Two of these patients died and one patient went on to liver transplantation.

    The researchers suggested that further studies would help determine the risk factors for HBV reactivation, define monitoring frequency, and identify patients who may benefit from HBV prophylaxis and treatment.

    No consistent results regarding which DAA regimens lead to HBV reactivation suggests the potential for a class-effect with DAAs.

    The results highlight the need for early recognition of HBV-HCV co-infection and prompt treatment of clinically significant HBV reactivation, they stated.


    Mark L. Fuerst
    Staff Correspondent

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