title: Direct-acting antiviral treatment in adults infected with hepatitis C virus: Reactivation of hepatitis B virus coinfection as a further challenge.
abstract: Use of direct-acting antiviral drugs (DAAs) greatly improves management of adults infected with hepatitis C virus (HCV) whether patients are treatment-naive or unsuccessfully pre-treated. Several inhibitors of viral nonstructural proteins (NS3/4A protease, NS5A and NS5B polymerase) allow a rapid HCV clearance and increase rates of sustained virological response. Both the EASL and AASLD guidelines have recently published up-to-date recommendations for their use, addressing each HCV genotype and particular situations. However, management of patients coinfected with hepatitis B virus (HBV) has been developed by these guidelines with reference to cases of HBV reactivation reported during previous anti-HCV regimens containing interferon known active against both HBV and HCV. In the setting of the interferon-free HCV therapies with DAAs only, the possibility of HBV reactivation during treatment of hepatitis C is raised due to viral interferences in HCV/HBV coinfected persons. Herein, we report a case of early HBV reactivation during DAAs-based anti-HCV treatment (ledipasvir/sofosbuvir) in a patient having a resolved HBV infection and chronically infected with HCV genotype 4 and HIV. Moreover, we review similar recent cases of HBV reactivation in patients infected with HBV and HCV genotype 1 during treatment of hepatitis C by regimen incorporating other combination of DAAs (sofosbuvir/simeprevir or daclatasvir/asunaprevir). Due to the potential risk of early HBV reactivation in HCV/HBV-coinfected patients during interferon-free DAAs-based HCV therapies, altogether these cases highlight the necessity to closely monitor HBV coinfection, regardless its stage (chronic, occult, resolved), whatever HCV genotype or class of DAAs used.
authors.affiliation: Department of Virology, Biological and Pathological Center, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Anne
authors.initials: A
authors.lastname: De Monte
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Courjon
authors.affiliation: Digestive Center, Centre Hospitalier Universitaire de Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U895, Team 8, Hepatic Complications in Obesity, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, France.
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Anty
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Cua
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Alissa
authors.initials: A
authors.lastname: Naqvi
authors.affiliation: Department of Infectious Diseases, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Mondain
authors.affiliation: Department of Virology, Biological and Pathological Center, Centre Hospitalier Universitaire de Nice, France.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Cottalorda
authors.affiliation: Department of Virology, Biological and Pathological Center, Centre Hospitalier Universitaire de Nice, France. Electronic address: ollier.l@chu-nice.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Ollier
authors.affiliation: Department of Virology, Biological and Pathological Center, Centre Hospitalier Universitaire de Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medicine, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Giordanengo
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D060085:Coinfection / Q000821:virology; D006515:Hepatitis B virus / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000821:virology*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors
keywords: HBV reactivation; HCV Direct-Acting Antivirals; HIV infection; NS3/4A protease inhibitors; NS5A inhibitors; NS5B polymerase inhibitors