Hepatitis B reactivation has been reported during and after direct-acting antiviral treatment for hepatitis C, sometimes severe. Regulators added warnings to labelling for this reason.
Test HBsAg and anti-HBc before treatment. Patients who are HBsAg-positive need monitoring or prophylaxis according to guidelines; those with isolated anti-HBc need monitoring and evaluation if liver tests rise.
- Test HBsAg and anti-HBc in every patient before starting hepatitis C treatment.
- Monitor or give prophylaxis to HBsAg-positive patients per guidelines.
- Recheck liver tests if they rise during or after treatment in anti-HBc-positive patients.
- Confirm absence of cirrhosis before choosing a shortened regimen.
Why it matters
Clearing hepatitis C can unmask hepatitis B, and the check takes one blood test.
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