No evidence of hepatitis B virus reactivation in patients with resolved infection treated with direct‐acting antivirals for hepatitis C in a large real‐world cohort

Summary Background Hepatitis B virus (HBV) reactivation has been observed following interferon (IFN)‐based treatment in HBV/hepatitis C virus (HCV) co‐infected patients. Recent reports suggest that reactivation may also occur in both hepatitis B surface antigen (HBsAg)‐positive and HBsAg‐negative patients during HCV treatment with direct‐acting antivirals (DAAs). Aim To investigate the rate of patients with HBV reactivation during IFN‐based and IFN‐free HCV treatment in a large real‐world cohort. Methods A total of 848 patients with chronic hepatitis C were treated with different combinations of DAAs. Among patients with available outcome and HBV data, there were 272 patients hepatitis B core antibody (HBcAb)‐positive (HBsAg‐positive, n=9; HBsAg‐negative, n=263), and 536 were HBcAb‐negative. All HBcAb‐positive patients were tested for HBV DNA at the end of DAA therapy and alanine transaminase (ALT) levels were frequently measured during therapy and follow‐up. Results Seventy‐three percent (n=192/263) of HBsAg‐negative/HBcAb‐positive patients had elevated ALT levels at baseline, which declined to normal values in all but 18 patients, and no HBV reactivation was observed. Eight patients had detectable but not quantifiable HBV DNA (