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DAA therapy effective in patients coinfected with HBV/HCV

Results of a recently published prospective study showed that direct-acting antiviral therapy is effective in patients coinfected with hepatitis B and hepatitis C and most patients with HBV reactivation had later resolution.

“The data on the efficacy of DAA regimens in HBV/HCV chronic coinfection are very few, and suggest a possible reactivation of HBV infection (rHBV) after HCV control,” the researchers wrote. “rHBV may arise in those without control of HBV replication by [a nucleos(t)ide treatment (NUC)], with potentially severe liver damage. Thus, it seems reasonable to suggest NUC-therapy for all HBsAg/anti–HCV-positive patients treated with a DAA-regimen, especially those with a severe disease.”

The researchers enrolled 29 DAA-naive patients with HBV/HCV coinfection into the prospective study between April 2015 and March 2016. Median patient age was 61 years (range, 38-80 years), 27 were men, 25 has cirrhosis and six had a history of liver transplantation.

At the start of therapy, 16 patients negative for HBV-DNA underwent nucleos(t)ide treatment. The rest of the patients, including one patient who was HBeAg-positive and five patients positive for HBV-DNA, did not receive nucleos(t)ide treatment.

Twenty-three patients were HCV-RNA negative at 1 month and all patients achieved sustained virologic response at week 12. There were no significant differences among the patients for demographic, virological or clinical characteristics.

During treatment, five patients had reactivation of HBV. Cases of reactivation occurred in two patients at 1 month, one patient at 3 months, one patient at 4 months and 1 patient at the end of therapy. All patients with HBV reactivation received NUC-rescue treatment except for the patient whose reactivation occurred at the end of therapy, as they had a low HBV titer and no biochemical HBV reactivation. Reactivation was resolved in all patients except one who underwent orthotopic liver transplantation.

“The present investigation showed that DAA regimens [were] effective in suppressing HCV replication in patients with chronic HBV/HCV coinfection,” the researchers concluded. “However, DAA treatment is effective and safe for patients taking an NUC at the same time; instead, nearly 40% of the patients in the NUC-sparing group developed rHBV and prompt NUC-rescue therapy did not prevent hepatic liver failure in 2 cases.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.