title: Hepatitis due to Reactivation of Hepatitis B Virus in Endemic Areas Among Patients With Hepatitis C Treated With Direct-acting Antiviral Agents.
abstract: Hepatitis due to reactivation of hepatitis B virus (HBV) has been reported in patients treated with direct-acting antiviral (DAA) agents for chronic hepatitis C virus infection. We performed an observational study to determine the incidence of and factors associated with hepatitis in 327 patients receiving pan-oral DAA agents for HCV infections in areas endemic for HBV in China. Ten patients were positive for hepatitis B surface antigen (HBsAg), and 124 patients had occult HBV infection. HBV reactivation was determined by measuring HBV DNA and HBsAg status in serial serum samples collected every 2 weeks during DAA treatment and then every 4 weeks after treatment until week 12. In the total study population, 10 patients (3.1%) had hepatitis; 3 cases were associated with HBV reactivation (1 case not in the icteric phase, 1 case in the icteric phase, and 1 case with liver failure) and 7 from other causes. Testing positive for HBsAg before DAA treatment was a strong risk factor for developing hepatitis during treatment (hazard ratio, 15.0; P < .001).
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China; State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.affiliation: Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China; Liver Failure Treatment and Research Centre, 302 Hospital, Beijing, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Ji
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Shao
authors.affiliation: Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
authors.forename: Jialiang
authors.initials: J
authors.lastname: Liu
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China.
authors.forename: April
authors.initials: A
authors.lastname: Wong
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China.
authors.forename: Yudong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Xiaoyong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Lu
authors.affiliation: Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China.
authors.forename: Chris
authors.initials: C
authors.lastname: Wong
authors.affiliation: Hong Kong Molecular Pathology Diagnostic Centre, Hong Kong SAR, China.
authors.forename: Stella
authors.initials: S
authors.lastname: Tsang
authors.affiliation: Institute of Translational Hepatology, 302 Hospital, Beijing, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Sun
authors.affiliation: State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Jinlin
authors.initials: J
authors.lastname: Hou
authors.affiliation: Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
authors.forename: Guofeng
authors.initials: G
authors.lastname: Chen
authors.affiliation: Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China; Second Liver Cirrhosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China; Institute of Translational Hepatology, 302 Hospital, Beijing, China. Electronic address: gkklau@netvigator.com.
authors.forename: George
authors.initials: G
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D002681:China / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood; D019353:Endemic Diseases; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens
keywords: Coinfection; Prognostic Factor; Risk Factor; Therapy