Hepatitis B Virus Reactivation In Patients Treated With Direct Acting Antiviral For HCV/HBV Co-infection: A Meta-analysis And Clinical Observation

Objective:By means of Meta analysis and clinical case study,the risk of HBV reactivation in HCV/HBV overlapping infection patients treated with DAA and the effect of HBV reactivation on the efficacy of DAA against HCV were preliminarily discussed,providing theoretical basis for rational drug use and prevention of HBV reactivation after anti-HCV treatment in HCV/HBV co-infection patients.Methods:1.A Meta-analysis was used to study the risk factors related to HBV reactivation after treatment with DAA in HCV/HBV co-infected patients.Computer searches of foreign language databases Pub Med,Web of Science,EMBASE and Chinese databases Zhiwang,Wanfang and Wei Pu platforms were conducted from2012 to 2021 in HCV/HBV co-infected patients.The literature related to risk factors for HBV reactivation after DAA treatment was hand-searched for relevant information.The acquired literature was screened,information extracted and quality evaluated in strict accordance with the inclusion and exclusion criteria,and the statistical software Review Manager 5.3 and Stata 15.1 software were applied for Meta-analysis after completion.2.39 patients with HCV/HBV superinfection in the outpatient and inpatient departments of the Affiliated Hospital of Guizhou Medical University from 2019 to 2021 were retrospectively collected as the research objects.The efficacy of DAA drugs in anti HCV treatment and the rate of HBV reactivation were observed 12 weeks after treatment.The severity of the disease(liver fibrosis,compensated cirrhosis,decompensated cirrhosis),blood cell analysis,liver and kidney function,HCV RNA,HBs Ag,HBe Ag,anti-HBc,anti-HBe,anti-HBs,HBV DNA,hepatitis C genotyping,type of DAA,and whether to receive anti HBV treatment with nucleoside(acid)analogues at the beginning of DAA treatment were taken as observation indexes for comprehensive analysis.Spss26.0 statistical software was used.The measurement data are expressed by means±standard deviation(?x±s),Chi square test was used to compare the rates.Analysis of variance was used for comparison between groups,and the difference was considered statistically significant(P<0.05).Results:1.A total of 18 articles(all in English)were included in the Meta-analysis;A total of 2325 cases were included.The results showed that during DAA treatment,HBs Ag positive patients did not receive prophylactic anti HBV treatment,and the overall risk of HBV reactivation was 23%(95%CI:0.14-0.36,P<0.001).The risk rate of HBV reactivation in HBs Ag positive patients after DAA treatment was greater than that in HBs Ag negative/anti-HBc positive patients,OR=17.29(95%CI:7.44-40.21,P<0.001).The risk of HBV reactivation in HBs Ag negative/anti-HBc positive patients was 2%.In the course of DAA treatment for patients with HCV/HBV coinfection,the combined risk of HBV reactivation related hepatitis in HBs Ag positive patients was 10%,while HBs Ag negative patients did not have HBV reactivation related hepatitis.2.In clinical observation,HCV RNA was the dominant virus strain in patients with HCV overlapping HBV infection,a total of 110 cases(72.17%)(χ~2=12.425,P=0.000).In this study,15 patients(38.46%)with HCV/HBV superinfection were mainly anti-HBs positive and anti-HBc positive;The second was anti-HBc positive in 8 cases(20.51%);The third was HBs Ag positive,anti-HBe positive and anti-HBc positive,a total of 5 cases(12.82%).In this clinical observation,39 patients with HCV overlapping HBV infection were treated with DAA,and the SVR was 94.87%(37/39)at 12 weeks;ALT(f=15.983,p=0.000)and AST(f=14.989,p=0.000)were significantly lower in patients with HCV overlapping HBV infection treated with DAA than before treatment.In this clinical observation,no HBV reactivation was found in patients with HCV overlapping HBV infection treated with DAA due to prophylactic anti HBV treatment with nucleoside(acid)analogues.Conclusions:In the course of DAA treatment for patients with hcv/hbv coinfection,the risk rate of HBV reactivation in HBs Ag positive patients was 23%,and the combined risk of HBV reactivation related hepatitis was 10%;(2)Hcv/hbv superinfection,HBs Ag positive patients can effectively prevent HBV reactivation by receiving anti HBV treatment while receiving DAA treatment;(3)In the course of DAA treatment for patients with hcv/hbv coinfection,HBs Ag negative and anti HBC positive patients may still have HBV reactivation,with a risk rate of 2%.No hepatitis related to HBV reactivation occurs;(4)The virological pattern of hcv/hbv coinfection patients was HCV RNA positive/hbv DNA negative.