直接抗病毒药物时代HBV/HCV重叠感染的治疗

Treatment of HBV/HCV co-infected patients in DAA era

亚太地区,尤其是我国,为HBV感染高发地区,自2011年口服直接抗病毒药物(DAA)问世以来,抗HCV的治疗逐渐从IFN为基础的方案转向全口服药物方案。进入DAA抗HCV治疗的时代后,陆续观察到HBV再激活的发生,相比IFN治疗时期,HBV再激活发生得更早、更严重,甚至有HBV再激活相关的死亡病例及肝移植病例的报道。因此,全世界各大肝病学会都高度重视DAA时代HBV再激活的发生,此类药物的说明书也新增了黑框药物用药安全警示,警示患者在接受DAA抗HCV治疗前,必须筛查HBV感染标志物,并在开始DAA抗HCV治疗前、治疗中及治疗后,密切检测HBV再激活的发生,并且在必要时,及时开始启动抗HBV治疗。

Asian-pacific area,especially China,is Hepatitis B high epidemic area. Since 2011,the first generation of oral direct anti-HCV agents（DAAs） came to clinical use,the treatment of chronic hepatitis C has switched from interferon-based regimen era to DAA era.There is an increased awareness of hepatitis B（HBV） reactivation in chronic hepatitis C（CHC） patients coinfected with HBV treated with pan-oral direct-acting antivirals（DAAs）. Compared with interferon-based regimen,HBV reactivation occurred earlier and more severe among patients received DAA regimen,and even fetal cases or case end up with liver transplantation was reported. Thus,association of liver diseases called to alert the occurrence of HBV reactivation among CHC patients who received DAAs regimen. It is hence important to have HBV serology screened in all CHC patients before initiation of pan-oral DAAs therapy and the usefulness of preemptive administration of effective anti-HBV nucleos（t） ide analogues in coinfected patients need to be further studied.