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Low risk of HBV reactivation in a large European cohort of HCV/HBV coinfected patients treated with DAA.
Expert Review of Anti-infective Therapy ( IF 4.2 ) Pub Date : 2020-06-27 , DOI: 10.1080/14787210.2020.1782189
Jerzy Jaroszewicz 1 , Małgorzata Pawłowska 2 , Krzysztof Simon 3 , Dorota Zarębska-Michaluk 4 , Beata Lorenc 5 , Jakub Klapaczyński 6 , Magdalena Tudrujek-Zdunek 7 , Marek Sitko 8 , Włodzimierz Mazur 9 , Ewa Janczewska 10 , Katarzyna Paluch 11 , Dorota Dybowska 2 , Iwona Buczyńska 3 , Agnieszka Czauż-Andrzejuk 12 , Hanna Berak 13 , Rafał Krygier 14 , Maciej Piasecki 1 , Beata Dobracka 15 , Jolanta Citko 16 , Anna Piekarska 17 , Łukasz Socha 18 , Zbigniew Deroń 19 , Olga Tronina 20 , Łukasz Laurans 18, 21 , Jolanta Białkowska 22 , Krzysztof Tomasiewicz 7 , Waldemar Halota 2 , Robert Flisiak 12
Affiliation  

ABSTRACT

Objectives

The aim of the study was to analyze the prevalence and clinical characteristics of HCV/HBV coinfection and to evaluate the rate of HBV-reactivation during anti-HCV therapy in a large real-world study.

Methods

Analyzed population consisted of 10,152 chronic hepatitis C patients treated with DAA between 2015 and 2019 in a nationwide study. Prior to the DAA all subjects had HBsAg and 60% anti-HBc testing.

Results

111 of 10,152 patients (1.1%) had detectable HBsAg and 1239 of 6139 (20.2%) anti-HBcAb. The prevalence of occult hepatitis B was 0.48%. HCV/HBV patients were younger with a higher proportion of males, HIV-coinfected, and advanced fibrosis. They were less often diagnosed with diabetes but more often with chronic kidney disease. In HBsAg(+) subjects with baseline HBV-DNA available 6/102 (5.9%) HBV-reactivations during or after DAA therapy were observed, and in two (1.9%) significant hepatic flares were noted. In HBsAg(-)/anti-HBc(+) group 2 (0.16%) reactivations were observed only in patients undergoing immunosuppressive therapy.

Discussion

Data from a large European cohort suggest a relatively low risk of HBV-reactivation during DAA-therapy for HCV infection in HBsAg(+) patients. In HBsAg(-)/anti-HBc(+) HBV-reactivation seems to be limited to subjects with immunodeficiency. Importantly, previous exposure to HBV and occult hepatitis B is present in a significant proportion of HCV-infected.



中文翻译:

在欧洲大量接受DAA治疗的HCV / HBV合并感染患者中,HBV再次激活的风险较低。

摘要

目标

这项研究的目的是分析HCV / HBV合并感染的患病率和临床特征,并在大规模的真实研究中评估抗HCV治疗期间HBV的再激活率。

方法

在一项全国性研究中,2015年至2019年间,接受分析的人群包括10152例接受DAA治疗的慢性丙型肝炎患者。在DAA之前,所有受试者均进行了HBsAg和60%的抗HBc检测。

结果

10152例患者中有111例(1.1%)有可检测到的HBsAg,6139例患者中有1239例(20.2%)抗-HBcAb。隐匿性乙型肝炎的患病率为0.48%。HCV / HBV患者较年轻,男性比例较高,HIV感染和晚期纤维化程度较高。他们很少被诊断出患有糖尿病,而更常被诊断出患有慢性肾脏疾病。在具有基线HBV-DNA的HBsAg(+)受试者中,观察到在DAA治疗期间或之后HBV的重新活化率为6/102(5.9%),并且在两个(1.9%)的肝脏中出现了明显的耀斑。在HBsAg(-)/ anti-HBc(+)组2(0.16%)中,仅在接受免疫抑制治疗的患者中观察到了激活。

讨论区

来自欧洲一个大型队列的数据表明,在DAs治疗期间,对于HBsAg(+)患者的HCV感染,HBV再次激活的风险相对较低。在HBsAg(-)/抗HBc(+)中,HBV重新激活似乎仅限于免疫缺陷患者。重要的是,以前有大量的HCV感染者曾接触过HBV和隐匿性乙型肝炎。

更新日期:2020-06-27
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