Test Hepatitis C Patients for Hepatitis B Before Treatment, Panel Advises

The American Association for the Study of Liver Diseases/Infectious Diseases Society of America Guidance Panel has updated its guidelines concerning patients beginning antiviral therapies for the treatment of hepatitis C virus (HCV). The Guidance Panel now recommends that all such patients be screened for the hepatitis B virus (HBV) as well.

The changes to the guidelines came after researchers observed cases of HBV reactivation in HBV/HCV co-infected patients during direct acting antiviral (DAA) treatment for HCV.

“The severity of these cases have ranged from mild to severe fulminant liver injury that can be life threatening,” Raymond Chung, MD, co-chair of the HCV Guidance Panel, said in a statement.

In the announcement, the Panel recommended additional precautions such as HBV vaccination for susceptible patients and beginning therapy for patients who meet the criteria for treatment of HBV before or in conjunction with DAA therapy for HCV. It also advised that patients with low or undetectable HBV DNA levels be tested regularly (generally not more than every 4 weeks) for HBV reactivation during treatment.

Chung explained that researchers are not sure how often the reactivation of HBV actually occurs, but the Guidance Panel is taking precautionary measures by updating the guidelines to include HBV testing. Susanna Naggie, MD, MHS, co-chair on the Guidance Panel, concurred that the monitoring is recommended even though “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.”

Previous recommendations for testing prior to the start of antiviral therapy for HCV have included performing a complete blood count and a hepatic function panel among other tests, as well as assessment of any potential drug-drug interactions with the patient’s concomitant medications.