HBV reactivation during hepatitis C treatment.

Silent Danger: Are Your Hepatitis C Meds Triggering a Hidden Virus?

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Reese Marlowe in Health & Wellness August 2025 • 4 min read.

"Understanding the potential for HBV reactivation during DAA therapy and what it means for your liver health."


The introduction of direct-acting antivirals (DAAs) has marked a new era in the treatment of hepatitis C virus (HCV) infection. These medications offer high cure rates and improved tolerability compared to previous interferon-based therapies. However, as we celebrate these advancements, it’s crucial to remain vigilant about potential side effects and unintended consequences.

One such concern is the risk of hepatitis B virus (HBV) reactivation in patients who have a history of HBV infection, even if it's considered resolved. This means that even if you've cleared the HBV infection, the virus can potentially become active again during or after DAA therapy for hepatitis C. Understanding this risk is vital for both patients and healthcare providers to ensure safe and effective treatment.

Recent research has shed light on this complex interaction between HCV, HBV, and DAA therapy, prompting a closer look at how we screen, monitor, and manage patients undergoing treatment for hepatitis C. The goal is to minimize the risk of HBV reactivation and protect the long-term liver health of individuals undergoing DAA therapy.

Decoding HBV Reactivation: What the Studies Reveal

HBV reactivation during hepatitis C treatment.

Several studies have investigated the potential for HBV reactivation in patients undergoing DAA therapy for hepatitis C. The findings have been somewhat varied, highlighting the complexity of the issue. Some studies have reported cases of HBV reactivation, while others have not. These differences can be attributed to variations in study design, patient populations, and the definitions used for HBV reactivation.

One key point of contention is how virological HBV reactivation is defined. Different studies use different criteria, making it challenging to compare results. For example, some define reactivation as an increase in HBV-DNA levels above a certain threshold, while others define it as the reappearance of HBsAg (hepatitis B surface antigen) in someone who was previously HBsAg negative. This lack of standardization makes it difficult to determine the true risk of HBV reactivation during DAA therapy.

What to Consider:
  • Definition differences affect reported reactivation rates.
  • Occult HBV infection may be missed without baseline testing.
  • Changes in HBV DNA levels during treatment are not always known.
  • Varied study designs impact overall conclusions.
A study by Ogawa et al. highlighted the risk of HBV reactivation in patients with resolved HBV infection (negative for HBsAg and undetectable HBV DNA but positive for HBcAb – hepatitis B core antibody). The study found that a percentage of patients with resolved HBV infection developed detectable HBV DNA during treatment with sofosbuvir-based regimens. In some cases, patients experienced transient HBV replication with a low-level of HBV DNA. This suggests that even in individuals with resolved HBV, there is a potential for the virus to reactivate during DAA therapy.

Protecting Your Liver: What You Need to Know

Given the potential risk of HBV reactivation during DAA therapy, it’s essential to discuss your HBV status with your healthcare provider before starting treatment for hepatitis C. If you have a history of HBV infection, even if it's considered resolved, your doctor may recommend additional monitoring during and after DAA therapy. Large-scale prospective studies are needed to confirm the risk of HBV reactivation in patients with resolved HBV infection treated with DAAs. This may involve regular blood tests to check your HBV DNA levels and liver function. If HBV reactivation is detected, antiviral treatment for HBV may be necessary to prevent liver damage.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/apt.14227, Alternate LINK

Title: Letter: The Potential Risk Of Hbv Reactivation In Patients With Resolved Hbv Infection During Direct-Acting Antiviral Therapy

Subject: Pharmacology (medical)

Journal: Alimentary Pharmacology & Therapeutics

Publisher: Wiley

Authors: R. Huang, J. Wang, Y. Hao, X. Yan, C. Wu

Published: 2017-09-07

Everything You Need To Know

1

What is HBV reactivation in the context of hepatitis C treatment with direct-acting antiviral (DAA) therapy?

Direct-acting antiviral (DAA) therapy, while effective for hepatitis C, can potentially trigger hepatitis B virus (HBV) reactivation in individuals with a past HBV infection, even if resolved. This means that someone who has cleared HBV could see the virus become active again during or after DAA therapy for hepatitis C.

2

How is virological HBV reactivation defined, and why does the variation in definitions matter?

Virological HBV reactivation is defined differently across studies. Some define it as an increase in HBV-DNA levels above a certain threshold, while others define it as the reappearance of HBsAg (hepatitis B surface antigen) in someone who was previously HBsAg negative. These differing definitions make comparing study results and determining the true risk challenging.

3

What did the study by Ogawa et al. reveal about HBV reactivation in patients with resolved HBV infection undergoing DAA therapy?

Ogawa et al. found that some patients with resolved HBV infection (negative for HBsAg and undetectable HBV DNA but positive for HBcAb – hepatitis B core antibody) developed detectable HBV DNA during treatment with sofosbuvir-based regimens. Some experienced transient HBV replication with a low level of HBV DNA, suggesting reactivation is possible even in resolved cases.

4

What steps should someone with a history of HBV infection take before starting DAA therapy for hepatitis C?

If you have a history of HBV infection, even if resolved, discuss it with your healthcare provider before starting DAA therapy for hepatitis C. Your doctor may recommend regular monitoring during and after treatment. This might involve blood tests to check HBV DNA levels and liver function. If HBV reactivation is detected, antiviral treatment for HBV might be necessary to prevent liver damage.

5

Why are large-scale prospective studies needed to fully understand the risks of HBV reactivation during DAA therapy?

Large-scale prospective studies are needed to confirm the actual risk of HBV reactivation in patients with resolved HBV infection treated with DAAs. These studies would help standardize definitions of HBV reactivation and better quantify the risk. They would help determine long-term monitoring strategies to protect the liver health of individuals undergoing DAA therapy for hepatitis C who have a history of HBV infection.

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