Clinical Observational Study on HBV Reactivation After Direct-Acting Antiviral Therapy in HCV/HBV Coinfected Patients in Guizhou, China

Abstract

The objective of this study is to analyse the prevalence and clinical characteristics of HCV/HBV coinfection in Guizhou, and evaluate the rate of HBV reactivation during and after anti-HCV treatment in a real-world study. This retrospective study included 1652 patients with hepatitis C virus (HCV) infection who received direct-acting antiviral (DAA) therapy at the Guiyang Public Health Clinical Center between January 2018 and December 2022 Baseline, on-treatment and posttreatment data were collected, including HCV RNA, HCV genotypes, liver function, hepatitis B virus (HBV) markers (HBsAg, HBcAb) and HBV DNA levels. The HCV/HBV coinfection rate was analysed, and the risk of HBV reactivation and disease progression following DAA therapy was assessed. Among the 1652 HCV-infected patients, the HCV/HBV coinfection rate was 49.88% (824/1652). Of these, 5.08% (84/1652) were HBsAg-positive, while 44.79% (740/1652) were HBsAg-negative/HBcAb-positive with HBV DNA < 20 IU/mL. Compared to patients with HCV monoinfection, HBsAg-positive patients had a higher proportion of males, compensated and decompensated cirrhosis, hepatocellular carcinoma (HCC) and lower platelet (PLT) counts (χ² = 15.482, 46.101; F = 7.292; all p < 0.05). Differences in HCV genotype distribution were observed among various HBV immune status groups (χ² = 32.529, p < 0.05). The cumulative incidence of HBV reactivation in HCV/HBV coinfected patients treated with DAAs was 1.2% (10/824). Among these, the reactivation rate was 16.67% (9/54) in HBsAg-positive patients without prophylactic anti-HBV therapy and 0.1% (1/740) in HBsAg-negative/HBcAb-positive patients. Baseline HBsAg levels were significantly higher in patients with HBV reactivation than in those without reactivation (Z = -4.291, p < 0.05). No significant changes were observed in liver function or PLT levels after HBV reactivation compared to baseline (p > 0.05), and no cases of liver failure were reported. In Guizhou, a relatively high prevalence of HBsAg-positivity and a large proportion of past HBV exposure (HBsAg-negative/HBcAb-positive, HBV DNA < 20 IU/mL) were observed among HCV-infected patients. While HBV reactivation can occur in HCV/HBV coinfected patients undergoing DAA therapy, the overall risk is low. A baseline HBsAg level > 185 IU/mL is a significant risk factor for HBV reactivation.

Keywords: DAA; coinfection; hepatitis B virus; hepatitis C virus; reactivation.