Published online Jun 28, 2017. doi: 10.3748/wjg.v23.i24.4317
Peer-review started: February 4, 2017
First decision: February 27, 2017
Revised: March 28, 2017
Accepted: May 9, 2017
Article in press: May 9, 2017
Published online: June 28, 2017
Processing time: 150 Days and 3.5 Hours
The recent introduction of direct-acting antiviral drugs (DAAs) for treatment of the hepatitis C virus (HCV) has greatly improved the management of HCV for infected patients. These viral protein inhibitors act rapidly, allowing HCV clearance and increasing the sustained virological response rates. However, hepatitis B virus (HBV) reactivation has been reported in HCV/HBV co-infected patients. Hepatitis B reactivation refers to an abrupt increase in the HBV and is well-documented in patients with previously undetected HBV DNA due to inactive or resolved HBV infection. Reactivation can occur spontaneously, but in most cases, it is triggered by various factors. Reactivation can be transient, without clinical symptoms; however, it usually causes a hepatitis flare. HBV reactivation may occur regardless of HCV genotype and type of DAA regimen. HBV screening is strongly recommended for co-infected HCV/HBV patients before initiation and during DAA therapy regardless of HBV status, HCV genotype and class of DAAs used. HBV reactivation can be prevented with pretreatment screening and prophylactic treatment when necessary. Additional data are required to evaluate the underlying mechanisms of HBV reactivation in this setting.
Core tip: Hepatitis B reactivation is related to an abrupt increase in hepatitis B virus (HBV) replication in patients with inactive or resolved hepatitis B. Most cases of HBV reactivation resolve spontaneously, but the existence of continuous immune suppression leads to hepatitis flare development and then to progressive acute hepatic injury. The introduction of direct-acting antiviral drugs (DAAs) treatment increases the risk of HBV reactivation in hepatitis C virus (HCV) /HBV co-infected patients. The high incidence of HBV reactivation in these patients highlights the necessity for HBV pretreatment screening before initiation and during DAA therapy.