Abstract：
Hepatitis B (HBV) reactivation was observed to be more than 10% in patients receiving interferon-based therapy for hepatitis C (HCV) co-infection. At present, when direct-acting antiviral (DAA) has become the main treatment for HCV, there are few large-scale studies on the reactivation of HBV in these population. We studied HBV reactivation risk and prophylactic HBV treatment efficacy in HBV/HCV co-infected patients receiving DAA therapy. Relevant studies were selected from the Ovid-Medline, Ovid-EMBASE, Cochrane Central Register of Controlled Trials, KoreaMed, KMbase, and RISS databases through 4 September 2020. Data pooling was carried out using the random-effects method. We identified 39 articles with 119,484 patients with chronic (n = 1673) or resolved (n = 13,497) HBV infection under DAA therapy. When the studies were pooled, the HBV reactivation rate was 12% (95% confidence interval (CI) 6-19, I2 = 87%), indicating that this population needs careful attention. When stratified by baseline HBV DNA, the undetectable HBV DNA group showed a significantly lower risk of reactivation than the detectable HBV DNA group (odds ratio (OR) 0.30, 95% CI 0.11-0.86, I2 = 0%). Prophylactic HBV therapy reduced HBV reactivation risk (OR 0.25, 95% CI 0.07-0.92, I2 = 0%). Patients with a resolved HBV infection showed a negligible rate (0.4%) of HBV reactivation. In conclusion, patients with detectable HBV DNA levels warrant careful monitoring for HBV reactivation and may benefit from preventive anti-HBV treatment.
摘要：
在接受基于干扰素的丙型肝炎（HCV）共感染治疗的患者中，观察到乙型肝炎（HBV）再激活超过10％。目前,当直接作用抗病毒（DAA）已成为HCV的主要治疗方法时，在这些人群中，很少有关于HBV再激活的大规模研究。我们研究了接受DAA治疗的HBV/HCV共感染患者的HBV再激活风险和预防性HBV治疗效果。相关研究选自Ovid-Medline，Ovid-EMBASE,Cochrane中央控制试验登记册,KoreaMed,KMbase,和RISS数据库到2020年9月4日。使用随机效应方法进行数据汇集。我们确定了39篇文章，其中119,484例患者在DAA治疗下患有慢性（n=1673）或解决（n=13,497）HBV感染。当研究汇总时，HBV再激活率为12％（95％置信区间（CI）6-19，I2=87％），这表明这个人口需要小心注意。当按基线HBVDNA分层时，HBVDNA未检测组的再激活风险显著低于HBVDNA检测组(比值比(OR)0.30,95%CI0.11~0.86,I2=0%).预防性HBV治疗降低HBV再激活风险（OR0.25，95％CI0.07-0.92，I2=0％）。解决HBV感染的患者显示HBV再激活的可忽略不计的比率（0.4％）。总之,HBVDNA水平可检测的患者需要仔细监测HBV再激活,并且可能受益于预防性抗HBV治疗.
