Analysis of literature on HBV reactivation in HCV/ HBV coinfection after treatment with direct-acting antiviral drugs
10.3760/cma.j.issn.1008-5734.2017.06.007
- VernacularTitle:直接抗病毒药物致HCV/HBV共感染患者HBV再活动的文献病例分析
- Author:
Rui SONG
1
;
Fengxin CHEN
;
Haodong CAI
;
Jie YAN
Author Information
1. 100015,首都医科大学附属北京地坛医院感染中心
- Publication Type:Journal Article
- Keywords:
Antiviral agents;
Virus activation;
Risk factors
- From:
Adverse Drug Reactions Journal
2017;19(6):432-437
- CountryChina
- Language:Chinese
-
Abstract:
Objective To understand the clinical features and outcome of hepatitis B virus (HBV) reactivation after the direct-acting antiviral (DAA)treatment for hepatitis C virus (HCV)in HCV/ HBV coinfection. Methods Studies on HBV reactivation after DAA treatment for HCV in HCV/ HBV coinfections which were reported in PubMed from Jan 1,2011 to 31st Aug,2017 were searched and retrieved. After document screening,data extraction and quality evaluation,the data of the cases with HBV reactivation after treatment with DAA drugs for the HCV/ HBV coinfection were collected. A descriptive statistical analysis was performed. Results Data of a total of 17 cases were collected,which were from 13 case-reports. There were 10 males and 7 females,the age ranged from 46 to 83 years with the mean of 62 years. There were 3 HBsAg-positive,7 HBsAg-negative,and 7 HBsAg-unreported cases. Five of them had low level HBV DNA replication (230-2300 IU/ ml);in 11 cases HBV DNA was not detected and in 1 case it was not reported. Fourteen patients were planned to take DAA drugs for 12 weeks,3 cases were 24 weeks. Reactivation of HBV occurred in 12 patients during the course of DAA treatment (4 to 21 weeks after starting),in 5 cases occurred 4 to 28 weeks after the end of treatment. Twelve of the 17 patients experienced severe reactivation of HBV and significant symptoms of exacerbation of liver disease. The levels of alanine aminotransferase,aspartate aminotransferase and HBV DNA were significantly higher than before,of which 4 of them developed liver failure. After HBV reactivation,13 were treated with anti-HBV drugs,11 of them improved,while 2 of them had liver failure and underwent liver transplantation. Four cases got spontaneous cure. Three of the 4 liver failure patients had cirrhosis before DAA treatment. Conclusions DAA drugs may lead to HBV reactivation in HCV/ HBV coinfected patients. HBV reactivation occurs not only in the course of drug treatment,but also in the months after the withdrawal of medication. Anti-HBV drugs in the reactivated cases generally got good prognosis. The presence of cirrhosis before DAA treatment is a risk factor for liver failure after HBV reactivation. The status of HBV infection should be assessed and HBV DNA levels and liver function should be monitored during the DAA drugs treatments.
