My go to resource are the HCV Guidelines, so I pay special attention and share updates. More formally known as Recommendations for Testing, Managing, and Treating Hepatitis C, this living document is provided by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA), in collaboration with the International Antiviral Society–USA (IAS–USA). It is constantly being updated, and the most recent recommendations pertain to patients with a history of hepatitis B.
The updated HCV Guidelines recommend that all patients beginning hepatitis C treatment using direct acting antiviral (DAA) medications be assessed for hepatitis B (HBV). There is growing concern about the potential for HBV reactivation.
Raymond Chung, MD, co-chair of the HCV Guidance Panel, states, “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.” Chung goes on to say that the severity of this reactivation varies, ranging from mild to potentially life-threatening liver damage.
The HCV Guidelines also recommend:
- HBV vaccination for all people who are not immunized or have no 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.
In the U.S., the hepatitis B vaccine is routinely given to babies and is recommended for people with liver disease. Click here for more information.