Evaluation of Hepatitis B Reactivation Among 62,920 Veterans Treated With Oral Hepatitis C Antivirals
Evaluation of Hepatitis B Reactivation Among 62,920 Veterans Treated With Oral Hepatitis C Antivirals
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DOI：
10.1002/hep.29135
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发表时间：
2017-07-01
期刊：
影响因子：
13.5
通讯作者：
Backus, Lisa I.
中科院分区：
文献类型：
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作者：
Belperio, Pamela S.;Shahoumian, Troy A.;Backus, Lisa I.
乙型肝炎病毒（HBV）在丙型肝炎病毒感染个体接受直接作用抗病毒（DAA）治疗中再次激活已被报道。目前或既往HBV感染患者在DAA治疗背景下的总体风险尚不清楚。本评估的目的是识别和表征接受口服DAA治疗的退伍军人的HBV再激活。这项回顾性评估包括62290名丙型肝炎病毒感染的退伍军人完成口服DAA治疗。根据DAA开始前的HBV实验室数据确定每位退伍军人的基线HBV感染状况。为了评估HBV再激活和肝炎，我们鉴定了在DAA治疗期间或治疗后7天获得的所有乙型肝炎表面抗原（HBsAg）、HBV DNA和丙氨酸转氨酶结果。HBV再激活定义为先前阴性的人HBV DNA或HBsAg检测增加100 ~ 1000 IU/mL。DAA治疗前，85.5%（53,784/62,920）有HBsAg检测，0.70%（377/53,784）呈阳性；84.6%（53,237/62,920）进行乙型肝炎表面抗体检测，其中42.2%（22,479/53,237）呈阳性。总的来说，62290例接受DAA治疗的患者中有9例在接受DAA治疗时出现HBV再活化的证据。8例发生在已知hbsag阳性的患者中，1例发生在已知分离的乙型肝炎核心抗体阳性的患者中。另外17名患者的HBV DNA水平略有升高，但不符合HBV再激活的条件。在该队列中，9例HBV再激活患者中只有3例丙氨酸转氨酶升高峰值为正常上限的2倍。结论：不同程度的HBV再激活，即使在分离乙型肝炎核心抗体的情况下，伴或不伴肝炎都可能发生，尽管伴重型肝炎的发生很少见。
Reactivation of hepatitis B virus (HBV) has been reported in hepatitis C virus-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 hepatitis C virus-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 hepatitis B surface antigen (HBsAg), HBV DNA, and alanine aminotransferase results obtained while on DAA treatment or 7 days after. HBV reactivation was defined as a >1000 IU/mL 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 a hepatitis B surface antibody 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 hepatitis B core antibody-positive. Seventeen other patients had small increases 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 alanine aminotransferase elevations > 2 times the upper limit of normal. Conclusion: HBV reactivation of varying severity, even in the setting of isolated hepatitis B core antibody, with or without accompanying hepatitis can occur-though the occurrence of accompanying severe hepatitis was rare.