Direct-acting antivirals for hepatitis C can be followed by hepatitis B reactivation in people who carry both infections, sometimes severely, as hepatitis C clearance removes suppression of the B virus. Regulators added warnings to the labels of these drugs for this reason.
Test HBsAg, and ideally anti-HBc, before starting. Those who are HBsAg-positive need monitoring or prophylaxis according to hepatology advice. The test costs little; the reactivation can be fatal.
- Test HBsAg and anti-HBc before any direct-acting antiviral course for hepatitis C.
- Seek hepatology advice for an HBsAg-positive patient before starting.
- Check liver tests if a patient becomes unwell during or after a hepatitis C course.
- Record the hepatitis B status in the treatment plan so the next clinician sees it.
Why it matters
Shorter, simpler hepatitis C courses make it easier to skip the hepatitis B check that prevents reactivation.
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