The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recommend all patients beginning direct-acting antiviral treatment for hepatitis C virus infection be assessed for hepatitis B virus infection, according to a press release on an update to HCV guidance.
“Cases of HBV reactivation during or after DAA therapy for HCV have been reported in HBV/HCV coinfected patients who were not already on HBV suppressive therapy,” Raymond Chung, MD, co-chair of the HCV Guidance Panel and HCV Next Editorial Board member, said in the press release. “The severity of these cases has ranged from mild to severe fulminant liver injury that can be life-threatening. While we do not know how frequently this occurs, the Guidance Panel recommends HBV testing for all patients beginning DAA treatment for HCV.”
Under the updated guidance — posted on HCVguidelines.org — the panel recommends:
- HBV vaccination for all susceptible individuals;
- clinicians obtain a test from patients for HBV DNA before DAA therapy in those who could be actively replicating;
- starting patients who meet criteria for active HBV infection on HBV therapy at the same time or before the start of HCV DAA therapy; and
- monitoring patients with low or undetectable HBV DNA levels at regular intervals for HBV reactivation during treatments and placing those whose HBV DNA levels meet treatment criteria on HBV therapy.
Susanna Naggie, MD, MHS, co-chair of the HCV Guidance Panel and HCV Next Editorial Board member, said the recommendation is important for monitoring potential reactivation when patients on DAA therapy have elevated liver enzymes.
“While there currently isn’t enough data to make clear recommendations for patients who have been exposed to HBV and resolved the virus, whether spontaneous or after antiviral therapy, we recommend these patients be monitored for HBV reactivation,” Naggie said in the release. “This is particularly important in the event of unexplained increases in liver enzymes and during and/or after completion of DAA therapy.”
The guidance was last updated in July with changes reflecting the FDA’s approval of Epclusa (sofosbuvir/velpatasvir, Gilead Sciences) for all chronic HCV genotypes in adults. The combination drug was approved in June for patients with HCV regardless of cirrhosis status.
AASLD/ISDA. Recommendations for testing, managing, and treating hepatitis C. http://hcvguidelines.org/sites/default/files/HCV-Guidance_September_2016_a.pdf. Accessed September 19, 2016.
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