Updated Guidelines: Screen Hep C Patients For Hep B

Patients beginning hepatitis C virus (HCV) treatment with direct acting antiviral (DAA) therapies should also be screened for hepatitis B virus (HBV), according to updated guidelines from the American Association for the Study of Liver Diseases/Infectious Diseases Society of America.

Although cases of HBV reactivation have been reported during or after DAA therapy in individuals with HBV/HCV coinfection not already on HBV suppression therapy, the frequency of this is not well understood. For this reason, the panel updated their guidelines, recommending HBV screening for all patients beginning DAA treatment for HCV.

Additionally, the guidelines recommend that:

• HBV vaccination should be given to all at-risk individuals, including those not immunized or without evidence of immunization response.

• Screening for HBV DNA should take place prior to DAA therapy in patients who could be actively replicating.

• Patients who meet criteria for treatment of HBV should be given treatment at the same time or before HCV DAA therapy is begun.

• Patients with low or undetectable HBV DNA levels should be monitored regularly for reactivation during treatment.

“While there currently isn’t enough data to make clear recommendations for patients who have been exposed to HBV and resolved the virus, whether spontaneous or after antiviral therapy, we recommend these patients be monitored for HBV reactivation,” the authors concluded. “This is particularly important in the event of unexplained increases in liver enzymes and during and/or after completion of DAA therapy.”

—Michael Potts

People with hepatitis C should be tested for hepatitis b before starting antiviral therapies [press release]. Alexandria, VA: American Association for the Study of Liver Diseases; September 16, 2016. http://www.aasld.org/about-aasld/pressroom/people-hepatitis-c-should-be-tested-hepatitis-b-starting-antiviral-therapies. Accessed September 19, 2016.