Hepatitis B Reactivation Following Eradication of HCV with Direct-Acting Antiviral Drugs (DAAs) in a Cohort of Patients from Different Institutions in Egypt

Mohamed S Abdelbary; Reham Samir; Saeed M El-Nahaas; Rasha M H Shahin; Mohammad El-Sayed; Yasmine Gaber; Omnia Tantawi; Naglaa A Zayed; Ayman Yosry

doi:10.1016/j.jceh.2022.04.020

Hepatitis B Reactivation Following Eradication of HCV with Direct-Acting Antiviral Drugs (DAAs) in a Cohort of Patients from Different Institutions in Egypt

J Clin Exp Hepatol. 2022 Sep-Oct;12(5):1276-1284. doi: 10.1016/j.jceh.2022.04.020. Epub 2022 May 5.

Authors

Mohamed S Abdelbary¹, Reham Samir¹, Saeed M El-Nahaas¹, Rasha M H Shahin², Mohammad El-Sayed¹, Yasmine Gaber¹, Omnia Tantawi¹, Naglaa A Zayed¹, Ayman Yosry¹

Affiliations

¹ Endemic Medicine Department and Hepatology Unit, Faculty of Medicine, Cairo University, Egypt.
² Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt.

Abstract

Background: Concerns about HBV reactivation (HBVr) have been raised with the introduction of DAA for HCV treatment. The aim of the study was to assess the risk of HBVr in chronic HCV patients during or after DAA.

Methods: A cohort of 166 chronic HCV patients who were treated with SOF-based DAA regimens and initially positive for HBcAb total were evaluated; 10 HBsAg-positive, 156 had past HBV exposure (HBsAg-negative/HBcAb-positive). Laboratory investigations, including liver functions tests, HBV-DNA, LSM by Transient elastography, and ARFI together with serum markers of fibrosis; APRI and FIB-4 were done at baseline and after 12 weeks of DAAs therapy. HBV-DNA levels and liver functions were monitored for assessment of HBVr.

Results: Virological HBVr was diagnosed by ≥ 1 log10 IU/ml HBV-DNA levels in 2/166 patients (1.2%) among the whole HCV cohort, who were initially positive for HBsAg; 20%. Clinical HBVr (>3 folds liver enzyme elevation) was detected in one patient with virological HBVr. Conversely, none of past HBV-infected patients experienced HBVr. All patients achieved SVR12 and had a significant decline in serum transaminases, bilirubin, APRI, and LSM measurements after HCV eradication.

Conclusion: HBVr might be considered after successful eradication of HCV following DAAs therapy, especially among patients who are positive for HBsAg, while past HBV infection does not seem to be a predisposing condition to HBVr.

Keywords: ALT, Alanine Aminotransferase; APASL, Asian Pacific Association for the Study of the Liver; APRI, Aspartate-aminotransferase-to-platelet-ratio index; ARFI, Acoustic Radiation Forced Impulse; AST, Aspartate Aminotransferase; CUC-HF, Cairo University Center for Hepatic Fibrosis; DAA, Direct-acting antivirals; DAAs; DNA, Deoxyribonucleic acid; EASL, European Association for the Study of the Liver; FIB-4, Fibrosis-4; HBV reactivation; HBV, Hepatitis B virus; HBV-DNA; HBVr, Hepatitis B virus reactivation; HBcAb, Hepatitis B core antibody total; HBsAg, Hepatitis B surface antigen; HCV; HCV, Hepatitis C virus; LSM, Liver stiffness measurement; MOHP, Ministry of Health and Population; PCR, Polymerase chain reaction; PegINF, Pegylated Interferon; ULN, upper limit of normal.