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September 2016
PATIENT CARE AND SCIENCE
HCV Guidance Panel Recommends Assessment for HBV Prior to Treatment
All patients beginning hepatitis C (HCV) treatment using direct acting antiviral (DAA) therapies should be assessed for hepatitis B (HBV), according the latest update from the American Association for the Study of Liver Diseases and Infectious Diseases Society of America Guidance Panel, which provides up-to-date guidance on the treatment of hepatitis C on its website, HCVguidelines.org
  
“Cases of HBV reactivation (an increase of the HBV virus) during or after DAA therapy for HCV have been reported in HBV/HCV co-infected patients who were not already on HBV suppressive therapy,” explains Raymond Chung, MD, co-chair of the HCV Guidance Panel. “The severity of these cases have ranged from mild to severe fulminant liver injury that can be life threatening. While we do not know how frequently this occurs, the Guidance Panel recommends HBV testing for all patients beginning DAA treatment for HCV.” 
 
Additionally, the Guidance Panel recommends:
  • HBV vaccination for all susceptible individuals (i.e., those not immunized or without evidence of response to immunization)
  • Obtaining a test for HBV DNA prior to DAA therapy in patients who could be actively replicating (i.e., those who are HBsAg positive)
  • Starting patients who meet criteria for treatment of active HBV infection on therapy at the same time — or before — HCV DAA therapy is started
  • Monitoring patients with low or undetectable HBV DNA levels at regular intervals (usually not more frequently than every four weeks) for HBV reactivation during treatments and placing those whose HBV DNA levels meet treatment criteria on HBV therapy as recommended by the AASLD’s HBV treatment guidelines
”While there currently isn’t enough data to make clear recommendations for patients who have been exposed to HBV and resolved the virus, whether spontaneous or after antiviral therapy, we recommend these patients be monitored for HBV reactivation,” says Susanna Naggie, MD, MHS, co-chair of the HCV Guidance Panel. “This is particularly important in the event of unexplained increases in liver enzymes and during and/or after completion of DAA therapy.”
 
Visit HCVguidelines.org for more information about these newest recommendations and to view other sections of the HCV Guidance.


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