Article: Evaluation of Hepatitis B Reactivation among 62,920 Veterans treated with Oral Hepatitis C Antivirals—PS Belperio et al.
Source: Hepatology. 2017 Feb 27. doi: 10.1002/hep.29135. [Epub ahead of print]
Take Home Points & Comments – Alan Franciscus
The Veterans Administration reviewed records of 62,920 veterans who were treated with direct-acting antiviral (DAA) drugs to find out how many people had HBV reactivation. The analysis included testing for various markers of hepatitis B prior to and while on DAA therapy. In all 9 people of the 62,920 who were treated with DAA therapy had HBV reactivation—that’s .0143%.
This particular study provides us with the ‘real world’ information about HBV reactivation –it is information that we have to take seriously but it is an occurrence that is, fortunately, rare.
The Veterans Administration (VA) is a great proving ground for just about every type of information about hepatitis C because it is ‘real world’ information with a very large population of people with hepatitis C. It will also provide us important information about how we can eliminate hepatitis C since congress has made a commitment to the VA to fund HCV treatment.
Reactivation of hepatitis B virus (HBV) has been reported in hepatitis C virus (HCV) infected individuals receiving direct-acting antiviral (DAA) therapy. The overall risk among patients with current or prior HBV infection in the context of DAA treatment is unknown. The aim of this evaluation was to identify and characterize HBV reactivation among veterans treated with oral DAA therapy.
This retrospective evaluation included 62,290 HCV-infected veterans completing oral DAA treatment. Baseline HBV infection status for each veteran was identified from HBV laboratory data performed prior to DAA initiation.
To assess for HBV reactivation and hepatitis we identified all HBsAg, HBV DNA and ALT results obtained while on DAA treatment or seven days after. HBV reactivation was defined as a >3 log increase in HBV DNA or HBsAg detection in a person who was previously negative. Prior to DAA treatment 85.5% (53,784/62,920) had HBsAg testing and 0.70% (377/53,784) were positive; 84.6% (53,237/62,920) had an anti-HBs test of which 42.2% (22,479/53,237) were positive. In all, 9 of 62,290 patients treated with DAAs had evidence of HBV reactivation occurring while on DAA treatment. Eight occurred in patients known to be HBsAg positive and 1 occurred in a patient known to be isolated anti-HBc positive. Seventeen other patients had small increases (<3 log) in HBV DNA levels that did not qualify as HBV reactivation. Only 3 of the 9 patients identified with HBV reactivation in this cohort exhibited peak ALT elevations >2 times the upper limit of normal.
HBV reactivation of varying severity, even in the setting of isolated anti-HBc, with or without accompanying hepatitis can occur -though the occurrence of accompanying severe hepatitis was rare. This article is protected by copyright. All rights reserved.
© 2017 by the American Association for the Study of Liver Diseases.