Entecavir prevents HBV reactivation in individuals on DAA for HCV/HBV dual infection

For patients undergoing direct acting antiviral (DAA) therapy for hepatitis C virus (HCV)/hepatitis B virus (HBV) dual infection, cotreatment with entecavir helps avert reactivation of HBV, as shown in a study.

The study included 56 noncirrhotic patients with dual HCV/HBV infection. They were randomized to receive 12-week DAA alone (group 1; n=20), 12-week DAA plus 12-week entecavir (group 2; n=16), or 12-week DAA plus 24-week entecavir (group 3; n=20). The entire study lasted 72 weeks.

Efficacy endpoints were the occurrence of HBV reactivation (defined as an increase in HBV DNA level of >10 folds with quantifiable HBV DNA at baseline or presence of HBV DNA with prior unquantifiable HBV DNA) and clinical reactivation (characterized as serum alanine transaminase [ALT] concentration of >2 folds the upper limit of normal plus HBV reactivation).

Results showed that HBV DNA levels in group 1 increased significantly as early as week 4 following initiation of DAA, and this elevation persisted until end of study.

During DAA treatment, HBV reactivation occurred in 50 percent of patients in group 1. On the other hand, none of the patients in group 2 and group 3 experienced reactivation (p<0.001 for both comparisons).

HBV reactivation in group 2 and group 3 occurred 12 weeks after discontinuation of entecavir, with a cumulative incidence rate of 93.8 percent and 94.7 percent, respectively.

Three patients (5.4 percent; one in each group) developed clinical reactivation at week 48 and did not receive entecavir treatment.