- The Asian Pacific Association for the Study of the Liver (APASL) has issued new guidelines for patients with current/prior HBV coinfection receiving HCV direct-acting antivirals (DAAs).
- Experts reviewed data from 14 studies on HBV DNA reappearance and clinical reactivation among patients receiving DAA therapy.
- Across 8 studies, viral DNA/clinical reactivation occurred in 41.4% (67/162) of patients positive for HBV surface antigen (HBsAg+) over a mean of 3 months posttreatment.
- Among patients positive for anti-HBV core (anti-HBc) and/or anti-HBV surface (anti-HBs) antibodies at baseline, the 3-month rate was 0.91% (12/1317).
Recommendations for patients coinfected with HBV and HCV
- HBsAg should be evaluated at baseline in HBV-endemic areas.
- HBsAg+ patients with advanced fibrosis, cirrhosis, or prior hepatocellular carcinoma should receive preemptive treatment with nucleos(t)ide analogs (NAs).
- In the absence of these conditions, HBsAg+ patients should receive preemptive NAs or close monitoring during treatment and for 24 weeks thereafter.
- HBsAg-negative patients with anti-HBc/HBs antibodies should be tested for HCV RNA, HBsAg, and HBV DNA if liver function tests are abnormal during or after DAA treatment.
- NAs should be used to treat HBV reactivation.
- The above provides only an overview, and clinicians should consult the complete guidelines for details.
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