Hepatitis C Treatment Panel Calls For Hepatitis B Testing

Hepatitis B and C are caused by different viruses that can start as acute infections but turn chronic in some people and eventually lead to life-threatening liver damage, according to the Centers for Disease Control and Prevention. While there are vaccines to prevent hepatitis A and B, there is no vaccine for hepatitis C.

A new update to the guidelines for the treatment of hepatitis C recommends testing for the hepatitis B virus in all patients who are planning treatment with direct acting antiviral drugs.

Hep B and C are diseases caused by different viruses that can both start as acute infections but turn chronic in some people, eventually leading to life-threatening liver damage, according to the Centers for Disease Control and Prevention (CDC). While there are vaccines to prevent hep A and B, there is no vaccine for hep C.

Health officials estimate that some 3.5 million people in the US are infected with hep C. New direct-acting antiviral drugs approved in the last few years to treat the chronic infection of the virus have shown high cure rates with fewer side effects than traditional treatments with interferon.

The recommendation that calls for all patients beginning hep C treatment using direct acting antiviral (DAA) therapies be assessed for hep B is included in an update posted on hep C guidelines.org, the website sponsored by American Association for the Study of Liver Diseases, the Infectious Diseases Society of America and the International Antiviral Society-USA. It is based on an increase in the hep B virus seen in some patients, according to a news release posted on the site.

“Cases of hep B reactivation (an increase of the hep B virus) during or after DAA therapy for hep C have been reported in hep B/hep C co-infected patients who were not already on hep B suppressive therapy,” Raymond Chung, MD, co-chair of the hep C Guidance Panel, stated in the release. “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 hep B testing for all patients beginning DAA treatment for hep C.”

The guidance panel also recommends that all susceptible individuals receive hep B vaccination and hep B DNA testing before DAA therapy in patients who are HBsAG positive. It also calls for starting patients who meet criteria for treatment of active hep B infection on therapy either at the same time or before patients start hep C DAA therapy.

In addition, it recommends that patients with low or undetectable hep B DNA levels be monitored regularly for hep B reactivation during treatment and that those whose hep B DNA levels meet treatment criteria be given hep B therapy as recommended by the guidelines.

“While there currently isn’t enough data to make clear recommendations for patients who have been exposed to hep B and resolved the virus, whether spontaneous or after antiviral therapy, we recommend these patients be monitored for hep B reactivation,” Susanna Naggie, MD, co-chair of the hep C Guidance Panel, stated in the release. “This is particularly important in the event of unexplained increases in liver enzymes and during and/or after completion of DAA therapy.”

Related Coverage:

Eradication of Hepatitis C Dependent on Drug Users' Access to Treatment

Hep C: Concerns about Thyroid Disease and Interferon Treatment Noted

Study Looks at Barriers to Hepatitis C Treatment