LAUSR

INTRODUCTION There is limited research about HBV reactivation (HBVr) due to direct-acting antivirals (DAA) for HCV and most are limited by short duration of follow-up, small sample size and absence of baseline HBV-DNA. We aimed to determine the incidence and clinical course of HBVr in HBsAg and/or anti-HBcIgG positive patients treated with DAA for HCV. METHODS Seven centers retrospectively analysed their database on HCV patients treated with DAA between 2015 and 2019. Patients with HBV coinfection or resolved HBV infection were enrolled. Serum transaminases, HBsAg, HBeAg and HBV-DNA were followed every 4 weeks during DAA treatment and every 12 weeks after treatment. Entecavir or tenofovir disoproxil fumarate was started in case of HBVr. The development of HBVr, HBV flare, liver failure and mortality were determined. RESULTS 852 patients received DAA treatment for HCV. Among them, 35 (4.1%) had HBV co-infection and 246 (28.9%) had resolved HBV. 257 patients (53.3% male, mean age: 63±9) constituted the study group (29 with co-infection and 228 with resolved infection). Three patients with co-infection were HBV DNA positive. HBVr developed in 10 (34.5 %) HBsAg positive patients, either during (n=3) or 12 to 48 weeks after DAA treatment. HBV flare and acute liver failure developed in one patient (3.4%), each. Two patients with resolved infection developed HBVr (0.87%) and one (0.44%) had HBV flare. Overall, none of the patients died or underwent liver transplantation due to HBVr. CONCLUSION Patients with HBV/HCV co-infection have a high risk of HBVr after DAA treatment and should receive antiviral prophylaxis. Patients with resolved infection have a low risk of HBVr and can be monitored by serial ALT measurements.