Low risk of HBV reactivation in a large European cohort of HCV/HBV coinfected patients treated with DAA.,Expert Review of Anti-infective Therapy

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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

Department of Infectious Diseases and Hepatology, Medical University of Silesia , Katowice, Poland.
Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University , Poland.
Department of Infectious Diseases and Hepatology, Wrocław Medical University , Wrocław, Poland.
Department of Infectious Diseases, Jan Kochanowski University , Kielce, Poland.
Pomeranian Center of Infectious Diseases, Department of Infectious Diseases, Medical University of Gdańsk , Gdańsk, Poland.
Department of Internal Medicine and Hepatology, Central Clinical Hospital of the Ministry of Internal Affairs and Administration , Warsaw, Poland.
Department of Infectious Diseases and Hepatology, Medical University of Lublin , Lublin, Poland.
Department of Infectious and Tropical Diseases, Jagiellonian University Collegium Medicum , Kraków, Poland.
Clinical Department of Infectious Diseases in Chorzów, Medical University of Silesia , Katowice, Poland.
Department of Basic Medical Sciences in Bytom, Medical University of Silesia , Katowice, Poland.
Department of Infectious Diseases, Provincial Hospital , Kielce, Poland.
Department of Infectious Diseases and Hepatology, Medical University of Białystok , Białystok, Poland.
Outpatient Clinic, Hospital of Infectious Diseases in Warsaw , Warsaw, Poland.
Outpatient Clinic, State University of Applied Sciences in Konin , Poland.
Outpatient Clinic, Medical Center MedicalSpec , Wroclaw, Poland.
Outpatient Clinic, Regional Hospital, Medical Practice of Infections , Olsztyn, Poland.
Department of Infectious Diseases and Hepatology, Medical University of Łódź , Łódź, Poland.
Department of Infectious Diseases, Hepatology and Liver Transplantation, Pomeranian Medical University , Szczecin, Poland.
Ward of Infectious Diseases and Hepatology, Biegański Regional Specialist Hospital , Łódź, Poland.
Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw , Warszawa, Poland.
Outpatient Department, Multidisciplinary Regional Hospital , Gorzów, Poland.
Department of Infectious and Liver Diseases, Medical University , Łódź, Poland.

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。