Consensus recommendations for treatment of HCV in the setting of HBV coinfection
|All patients with HCV infection undergoing DAA therapy should be screened for HBV infection with anti-HBc, HBsAg and anti-HBs testing.||A1|
|Non-immune (HBsAg, anti-HBc and anti-HBs-negative) patients should be offered HBV vaccination.||A1|
Patients with HCV infection who are HBsAg-positive should be managed by, or in conjunction with, a specialist experienced in the treatment of both conditions.
|Patients should be counselled regarding the risk of HBV reactivation and advised to immediately report any signs or symptoms indicative of serious liver disease.||A1|
|All patients who are HBsAg-positive should undergo HBV DNA testing before commencing DAA therapy.||A1|
|Anti-HBV therapy with tenofovir or entecavir should be commenced in all non-cirrhotic patients with an HBV DNA level > 2000 IU/mL and in all patients with underlying cirrhosis, regardless of HBV DNA level.||A1|
Non-cirrhotic patients with an HBV DNA level < 2000 IU/mL should be monitored for evidence of HBV reactivation. We recommend the following minimum requirements for monitoring:
§ ALT — every 4 weeks until the end of treatment, and at SVR
§ HBV DNA — every 12 weeks until SVR, plus if ALT level rises
§ If HBV DNA level remains < 2000 IU/mL at SVR, routine monitoring as per HBV guidelines can be reinstituted.
|A rise in HBV DNA level > 2000 IU/mL at any time during therapy and/or elevation in ALT level accompanied by any rise in HBV DNA level should prompt consideration of antiviral therapy and intensive monitoring.||A1|
|Coinfected patients who are already receiving anti-HBV therapy and have suppressed HBV DNA levels do not appear to be at increased risk and can continue with routine clinical monitoring.||A1|
|Anti-HBc-positive, HBsAg-negative patients|
Patients who are anti-HBc-positive and HBsAg-negative have a low risk of HBV reactivation.
|Routine monitoring guidelines for patients treated with HCV DAAs should be followed, as recommended for people who are seronegative for HBV infection.||B1|
|HBV reactivation should be considered in any patient who experiences an ALT flare during or after DAA treatment.||A1|