Management and Treatment of Chronic HBV and HCV Co-Infection and the Impact of Anti-Viral Therapy

Abstract

Recent reports have demonstrated that chronic hepatitis B virus (HBV) can flare or reactivate when chronic hepatitis C virus (HCV) is treated with direct-acting anti-viral agents (DAAs). Understanding HBV and HCV co-infection is therefore important. Although 40–60% of patients with chronic HCV have been previously exposed to HBV; only about 1–6% has serologic evidence of co-infection. In some patients with co-infection, both HBsurface antigen and HBV DNA may be suppressed to undetectable levels by HCV. Complete serologic screening for HBV should be performed in all patients prior to initiating HCV treatment. Patients with HB surface antigen and isolated anti-HBcore require frequent monitoring during HCV treatment, and some will require treatment. The epidemiology of HBV, HCV, and co-infection; how these viruses interact within the host; the treatments for each virus; the risk of HBV flare during HCV treatment; and how patients with HBV should be managed during HCV treatment will be discussed.