4 Good Reasons to Worry about Hep C

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November 7, 2018

4 Good Reasons to Worry about Hep C
Andrew Bowser

Nov 6, 2018

The challenge of successfully treating infection with the hepatitis C virus (HCV) has been significantly reduced in this era of highly effective direct-acting antiviral (DAA) agents; however, there are still important issues for clinicians to be aware of, according to liver disease expert Mitchell L. Shiffman, MD.

“They're not challenges. You just need to be concerned about them,” Dr. Shiffman said in a presentation at the recent American College of Gastroenterology (ACG) meeting in Philadelphia.

While first- and second-line therapy for HCV is very effective, there are still a small number of DAA treatment failures that can be very challenging to manage, said Dr. Shiffman, liver disease expert at Bon Secours Liver Institute of Richmond, Va.

Other issues that should be on the radar:
Monitoring for chronic hepatitis B reactivation
Treatment of active drug users
Managing patients with end-stage renal disease

Read on to learn more about these key issues and comments on each Dr. Shiffman made at ACG.

Link: http://www.patientcareonline.com/article/4-good-reasons-worry-about-hep-c

Hepatitis B and C coinfection in a real-life setting: viral interactions and treatment issues

Ann Gastroenterol. 2018 May-Jun;31(3):365-370. doi: 10.20524/aog.2018.0255. Epub 2018 Mar 28.

Hepatitis B and C coinfection in a real-life setting: viral interactions and treatment issues.
Papadopoulos N1, Papavdi M2, Pavlidou A1, Konstantinou D2, Kranidioti H2, Kontos G2, Koskinas J2, Papatheodoridis GV3, Manolakopoulos S2, Deutsch M2.

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Abstract

Background:
Only limited data concerning hepatitis B (HBV) and C viruses (HCV) coinfection are available. Direct-acting antivirals (DAAs) may be more effective for HCV clearance than interferon (IFN)-based regimens with a risk of HBV reactivation.

Methods:
We retrospectively enrolled 40 HBV/HCV-coinfected patients to evaluate their clinical profile and treatment outcomes.

Results:
Chronic dual infection was present in 25/40 (62.5%) patients, acute HCV superinfection in 5/40 (12.5%) patients and acute HBV superinfection in 10/40 (25%). Twenty-five patients (62.5%) were treated: 16/25 (64%) with IFN, 4/25 (16%) with nucleot(s)ide analogs (NUCs) and 5/25 (20%) with DAAs. Of the 16 patients treated with IFN-based therapy, 6 (37.5%) achieved both sustained virological response (SVR) and HBsAg clearance. Of the 4 patients treated with NUCs, one (25%) achieved both SVR and HBsAg clearance. All five patients treated with DAAs (100%) achieved SVR, while one case of HBV reactivation was recorded. Fifteen of the 40 patients (37.5%) did not receive any treatment. Eight of them (53.5%) presented with acute HBV superinfection: spontaneous HCV clearance was recorded in 5/8 (62.5%), while HBsAg clearance occurred in 6/8 (75%). Three of them (20%) presented with acute HCV superinfection; spontaneous HCV clearance was recorded in one of the three (33.5%). The other four patients (26.5%) presented with dual HBV/HCV infection.

Conclusions:
A significant proportion of patients presented with active HBV replication. Treatment with DAAs seems to be efficacious for HCV eradication. However, clinicians should be aware of HBV reactivation. HBV superinfection may lead to both HBsAg and HCV clearance.

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