Rate of Hepatitis B Reactivation During DAA Therapy for Hepatitis C Virus

hepatitis B infection
hepatitis B infection
The absolute risk of hepatitis B virus reactivation in individuals with active or resolved infections who were treated with DAAs for hepatitis C virus.

According to the results of a study published in The Lancet Gastroenterology & Hepatology, direct-acting antiviral (DAA) therapy in patients with chronic hepatitis C virus (HCV) is associated with hepatitis B virus (HBV) reactivation in patients with chronic HBV but not with in patients with resolved HBV infection.

To determine the risk for HBV reactivation associated with DAA therapy for treatment of HCV, researchers conducted a systematic review and meta-analysis of 17 observational studies. Patients were categorized as having chronic HBV (n=242) or resolved HBV (n=1379). The quality and risk of bias were assessed by 2 independent researchers. The primary outcome was the rate of HBV reactivation in patients treated with DAA therapy.

Across all studies, 24% of patients with chronic HBV had HBV reactivation based on surface antigen positivity. No heterogeneity was reported across the studies (I2 0%; P =.71), and no publication bias was found.

Reactivation occurred in 1.4% of patients with resolved HBV. Again, no evidence of heterogeneity was reported (I2 0%; P =.84).

In patients with chronic HBV infection, 9% had HBV-reactivation-related hepatitis. In contrast, no HBV-reactivation-related hepatitis was reported in patients with resolved infections.

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The study investigators concluded that “the risk of HBV reactivation and HBV-reactivation-related hepatitis in DAA-treated patients is substantially higher than that previously reported in patients treated with interferon.” They added that the results “support the use of antiviral prophylaxis in patients with chronic HBV infection.”


Mücke MM, Backus LI, Mücke VT, et al. Hepatitis B virus reactivation during direct-acting antiviral therapy for hepatitis C: a systematic review and meta-analysis [published online January 19, 2018]. Lancet Gastroenterol Hepatol. doi:10.1016/S2468-1253(18)30002-5