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Abstract
Background: Concerns about hepatitis B virus reactivation (HBVr) were raised with introduction of direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. aim: Assessment of the risk of HBVr in chronic HCV patients during or after DAA treatment. methods: A cohort of 166 chronic HCV Egyptian patients treated with SOF-based DAA regimens and positive for HBcAb total was evaluated; ten were HBsAg-positive, while 156 had past HBV exposure (HBsAg-negative/HBcAb-positive). Laboratory investigations including HBV- DNA, liver stiffness measurements (LSM) by Transient elastography and Acoustic Radiation Forced Impulse (ARFI) together with serum markers of fibrosis; aspartate-aminotransferase-to-platelet-ratio index (APRI) and (FIB-4) were done before and after 12 weeks of DAA therapy. HBVr was assessed on and after DAA therapy. results: All HCV patients achieved SVR12 and exhibited significant decline of serum transaminases, bilirubin, APRI, LSM and CAP measurements after HCV eradication. Compared to HCV patients with past HBV infection; current HCV/HBV co-infected patients had significantly higher baseline AST and AFP. Virological HBVr was diagnosed in two patients with HBsAg-positive by {u2265} 1 log10 IU/ml HBV-DNA levels, among whom one patient had clinical HBVr (>3 folds liver enzyme elevation) 12 weeks after DAA therapy, while none of HCV/past infected patients experienced HBVr.Patients with HBVr, had significantly higher baseline LSM compared to other patients. HCC was diagnosed in one cirrhotic HBsAg-positive patient after stoppage of DAA therapy. conclusion: HBVr was evident among HCV with current HBV co-infection following DAA therapy while past HBV infection does not seem to be a predisposing condition to HBVr