Spontaneous Remission Of Hepatitis B Virus Reactivation During Direct-acting Antiviral Agent-based Therapy For Chronic Hepatitis C
Sato, K., Kobayashi, T., Yamazaki, Y., Takakusagi, S., Horiguchi, N., Kakizaki, S., Kusano, M., & Yamada, M. (2017). spontaneous remission of hepatitis B virus reactivation during direct-acting antiviral agent-based therapy for chronic hepatitis C. Hepatology research : the official journal of the Japan Society of Hepatology, 47(12), 1346–1353. https://doi.org/10.1111/hepr.12905
View Original Source →Abstract
The administration of direct-acting antiviral agents (DAAs) to treat hepatitis C virus (HCV) infection has been reported to cause hepatitis B virus (HBV) reactivation. However, the actual conditions of HBV reactivation and the ideal timing of medical intervention have not been fully evaluated. We report the cases of two female patients dually infected with HBV and HCV. Both patients were inactive HBV carriers. Although the serum HCV RNA levels promptly decreased after the initiation of DAA-based therapy, the serum HBV DNA levels gradually increased during DAA-based therapy, with the peak serum HBV DNA levels observed at 16 weeks after the initiation of DAA-based therapy in both cases. Subsequently, we checked the serum HBV DNA levels closely every week several times. Fortunately, the serum HBV DNA levels gradually decreased without medical intervention. Neither case developed an alanine aminotransferase flare-up. The HCV genotypes were 2a and 1b, and the DAA-based therapies of Cases 1 and 2 were 12 weeks of sofosbuvir/ribavirin and ombitasvir/paritaprevir/ritonavir, respectively. The significance of our case reports is the demonstration of the existence of spontaneous remission of HBV reactivation that developed during DAA-based therapy, the avoidance of intervention of nucleot(s)ide analogs by frequent monitoring of serum HBV DNA levels, and development of HBV reactivation regardless of the viral genotype or class of DAA. In conclusion, the close monitoring of serum HBV DNA levels during and after DAA-based therapy is essential and medical intervention for HBV reactivation should be carefully considered on an individual basis.
Case Details
Disease Location
Liver
Personal Characteristics
Patient 2} a 64-year-old woman developed acute hepatitis b at 33 years of age. The route of transmission was unknown. Hepatitis c virus infection was first pointed out at a medical check-up when she was 51 years of age was referred to the department after experiencing a relapse of uterine corpus cancer of the vagina at 59 years of age
Clinical Characteristics
Was scheduled to receive chemoradiotherapy and high-dose-rate intracavitary radiation therapy. Entecavir was then given during chemoradiotherapy and 1 year after the completion o this; it was discontinued in accordance with her wishes the serum HBV DNA level started to increase during the combination therapy with obv/patient/r and reached 2.7 log iu/ml at 16 weeks after the initiation of the combination therapy
Remission Characteristics
The patient achieved rapid virological response and the HCV RNA level remained undetectable after combination therapy forightunately, the serum HBV DNA level plateaued and gradually decreased, falling to a level that was similar to that at the baseline after 3 weeks of combination therapy. The difference between the peak and baseline serum HBV DNA levels was >1.4 log iu/ml finally, sustained virological response at 12 weeks after treatment was achieved
Treatment & Mechanisms
Proposed Remission Mechanisms
Not discussed
Clinical Treatment
After the completion of entecavir, treatment, the serum HBV DNA level gradually increased and reached 3.2 log iu/ml, but gradually decreased an sof-based regimen was avoided here, due to the potential for cardiac toxicity. We therefore administered combination therapy with obv (25 mg per day), patient (150 mg per day), and ritonavir (100 mg per day)