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Hepatitis B reactivation and outcomes in persons treated with directly acting antiviral agents against hepatitis C virus: results from ERCHIVES
Author(s) -
Butt A. A.,
Yan P.,
Shaikh O. S.,
AbouSamra A.B.
Publication year - 2018
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14426
Subject(s) - medicine , hbsag , regimen , hepatitis b virus , decompensation , gastroenterology , hepatitis b , hbeag , hepatitis d virus , pegylated interferon , ribavirin , hepatitis c virus , immunology , virus
Summary Background Higher risk of hepatitis B reactivation ( HBV ‐r) has been reported in patients with hepatitis C treated with newer directly acting antiviral agents ( DAA s). Aim To determine the proportion of persons who develop HBV ‐r and its clinical consequences among DAA treated vs pegylated interferon/ribavirin ( PEG / RBV ) treated persons. Methods We calculated the proportion of persons who developed HBV viral reactivation ( HBV ‐r; new detectable HBV DNA or increase of >1 log 10 ); serum alanine aminotransferase flare (>5 times baseline); all‐cause mortality and hepatic decompensation in persons treated with a newer DAA regimen or PEG / RBV . Kaplan‐Meier curves were used to demonstrate survival and hepatic decompensation by treatment group and HBV ‐r. Results In 34 632 persons treated with DAA and 23 475 treated with PEG / RBV , HBV ‐r rate per 1000 person‐years was 30.04 (10.41, 49.67) and 25.42 (95% CI 17.23, 33.62) respectively ( P = .8). When stratified by SVR or by baseline HB sAg status, HBV ‐r was not different between groups. Kaplan‐Meier survival curves comparing each regimen stratified by presence or absence of HBV ‐r did not demonstrate a significant difference in incidence of hepatic decompensation over time. For overall survival, there was no difference between PEG / RBV treated persons with or without HBV ‐r. For DAA treated persons, those with HBV ‐r had a shortened survival, though the numbers at risk were small. Conclusions HBV ‐r is relatively uncommon after DAA therapy and not higher than among those treated with a PEG / RBV regimen. The small numbers of persons treated with a DAA regimen who do develop HBV ‐r have a shortened survival compared to those without HBV ‐r.