HBsAg Loss Due to Tenofovir Treatment for HBV Reactivation Following DAAs Therapy in One Patient with HBV-HCV Coinfection

Hepatitis B virus(HBV)reactivation induced by administration of direct-acting antiviral agents(DAAs)to treat hepatitis C virus(HCV)infection has been reported in previous studies,the subsequent clinical outcomes varied from no symptom to liver failure or death,however,the timing of anti-HBV treatment is controversial.We report the clinical HBV reactivation in a 51 years old female fibrotic patient with chronic HBV-HCV infection during the paritaprevir/ritonavir/ombitasvir and dasabuvir(PrOD)therapy.Her baseline HCV RNA,HBV DNA,alanine aminotransferase(ALT),and liver stiffness measurement levels were 5,560,000IU/mL,<15IU/mL,48U/L,and 11.8 kPa,respectively.At 8weeks of PrOD treatment,her HCV RNA,HBV DNA,and ALT levels were<15IU/mL,2,880,000 IU/mL,and 837U/L,respectively,and clinical reactivation was diagnosed.Meanwhile,tenofovir was immediately used for anti-HBV treatment.Fortunately,HBV DNA and ALT were undetectable and normalized after 16weeks of anti-HBV therapy,and unexpectedly,hepatitis B surface antigen loss occurred at 80weeks of anti-HBV treatment.This study may extend our understanding of the timing of anti-HBV therapy to prevent potential HBV reactivation during DAAs treatment in HBVHCV coinfected patients,and proper initiation timing may lead to functional cure of chronic HBV infection.