Clearing hepatitis C with direct-acting antivirals can allow hepatitis B to reactivate in co-infected patients, occasionally causing severe hepatitis. The risk is highest with active hepatitis B surface antigen positivity, and lower but present with isolated core antibody.
Testing for HBsAg and anti-HBc before treatment, and planning monitoring or prophylaxis accordingly, prevents a cured patient returning with hepatitis from another virus.
- Check HBsAg and anti-HBc in every patient before starting hepatitis C treatment.
- Consider HBV antiviral prophylaxis for HBsAg-positive patients during and after DAA therapy.
- Monitor liver enzymes in anti-HBc-positive, HBsAg-negative patients during treatment.
- Vaccinate non-immune patients against hepatitis B.
Why it matters
Hepatitis B reactivation after HCV cure is preventable with one blood test at the start.
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