Jing Wang1,2, Chunhua Hu1, Yi Chen1, Zhengwen Liu1, Qiang Yu3, Shujuan Yang1,4, Jun Dong5, Yuan Yang1, Yuchao Wu1, Danfeng Ren1, Naijuan Yao1, Dandan Guo1, Zhen Tian1, Yingren Zhao1, Tianyan Chen1, Yingli He1, Jinfeng Liu1. 1. Department of Infectious Diseases, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an City, China. 2. Department of Rheumatology, First Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an City, China. 3. Department of Pediatric Surgery, Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an City, China. 4. Department of Infectious Diseases, The Eight Hospital of Xi'an, Xi'an City, China. 5. Department of Haemodialysis, Zhen'An County Hospital, Shangluo City, China.
Abstract
BACKGROUND: There have been increasing reports of HBV reactivation in HBV and HCV coinfected patients with direct-acting antiviral (DAA) treatment. The potential risk of HBV reactivation in patients undergoing haemodialysis has also been noted. There is a lack of data pertaining to the reactivation risk during DAA treatment in those coinfected patients with end-stage renal disease who are undergoing haemodialysis. METHODS: HBV-HCV-coinfected patients were screened from 178 persons at two blood purification centres in China and received sofosbuvir (200 mg) combined with daclatasvir (60 mg) daily. The risk and pattern of HBV reactivation during DAA treatment was retrospectively analysed. RESULTS: HBV reactivation occurred in 45.5% (5/11) of the HBV-HCV-coinfected patients undergoing haemodialysis during DAA treatment, which was much higher than the reported rates in the general population of coinfected patients. Five patients with HBV reactivation were all positive for hepatitis B surface antigen (HBsAg) before DAA treatment. Three patients (27.3%) had mild hepatitis flares due to HBV reactivation, but no patients had severe hepatitis or hepatic failure. Compared with the four patients who were HBsAg- at the baseline, the risk of HBV reactivation in HBsAg+ patients was greater (71.4% versus 0; χ2=5.238; P=0.061), although the difference was not statistically significant. CONCLUSIONS: A significant proportion of HBV-HCV-coinfected patients undergoing haemodialysis developed HBV reactivation after DAA therapy. The risk of HBV reactivation was greater in HBsAg+ patients than in those patients who were HBsAg- but anti-HBc+ or HBV DNA+.
BACKGROUND: There have been increasing reports of HBV reactivation in HBV and HCV coinfectedpatients with direct-acting antiviral (DAA) treatment. The potential risk of HBV reactivation in patients undergoing haemodialysis has also been noted. There is a lack of data pertaining to the reactivation risk during DAA treatment in those coinfected patients with end-stage renal disease who are undergoing haemodialysis. METHODS:HBV-HCV-coinfectedpatients were screened from 178 persons at two blood purification centres in China and received sofosbuvir (200 mg) combined with daclatasvir (60 mg) daily. The risk and pattern of HBV reactivation during DAA treatment was retrospectively analysed. RESULTS: HBV reactivation occurred in 45.5% (5/11) of the HBV-HCV-coinfectedpatients undergoing haemodialysis during DAA treatment, which was much higher than the reported rates in the general population of coinfected patients. Five patients with HBV reactivation were all positive for hepatitis B surface antigen (HBsAg) before DAA treatment. Three patients (27.3%) had mild hepatitis flares due to HBV reactivation, but no patients had severe hepatitis or hepatic failure. Compared with the four patients who were HBsAg- at the baseline, the risk of HBV reactivation in HBsAg+ patients was greater (71.4% versus 0; χ2=5.238; P=0.061), although the difference was not statistically significant. CONCLUSIONS: A significant proportion of HBV-HCV-coinfectedpatients undergoing haemodialysis developed HBV reactivation after DAA therapy. The risk of HBV reactivation was greater in HBsAg+ patients than in those patients who were HBsAg- but anti-HBc+ or HBV DNA+.