TABLE 5.
Characteristics of 6 patients with >4 log increases in HBV DNA during treatment or after treatment with direct-acting antivirals
| Age | Cirrhosis | Alcohol misusea | Baseline HBsAg+ | Pre-DAA treatment baseline HBV DNA (IU/mL) | Max HBV DNA increase (IU/mL) | Max ALT increase (IU/L) | Max total bili increase (μg/dL) | Time between start of DAA therapy and HBV DNA flare (d) | Time between start of DAA therapy and HBV treatment initiation (d) | HBV therapy | Outcome |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 58 | No | No | No | 0 | 10 902 | 15 | 0.1 | 28 | 38 | TDF | HBV DNA cleared |
| 64 | Yes | No | Yes | Unknown | 18 900 | 3 | 0.4 | 45 | 45 | TDF | Unknown |
| 53 | No | No | Yes | 27 900 | 254 304 | 9 | 1.1 | 316 | Started concomitant with DAA | FTC/TDF+ETV | HBV DNA dropped by 3-log |
| 60 | Yes | No | Yes | 0 | 1 559 851 | 241 | 0.2 | 194 | 195 | ETV | HBV DNA dropped by 6-log |
| 53 | No | No | Yes | 0b | 2 885 983 | 24 | 0 | 168 | Started concomitant with DAA | TDF | HBV DNA cleared |
| 56 | Yes | No | Yes | 2361 | >22 000 000 | 1467 | 17.3 | 57 | 67 | FTC/TDF | HBV DNA cleared |
DAA, direct-acting antiviral; HCV, hepatitis C virus; TDF, tenofovir; FTC, emtricitabine; ETV, entecavir; bili, bilirubin; ALT, alanine aminotransferase.
a
Alcohol misuse was identified with the alcohol use disorder identification test, score ≥4 for males and ≥3 for females indicates hazardous drinking.
b
HBV DNA was available within 1.5 y of DAA start date.