Hepatitis B May Flare During Hepatitis C Treatment

Background:  Sofosbuvir (Sovaldi) and simeprevir (Olysio) have shown great promise in eradicating hepatitis C.
Two case reports of co-infected hep B and hep C patients.  Both were HIV-negative men in their mid-50s.
Prior tx with peginterferon and ribavirin had failed.
Patient 1: HBV DNA 2300 IU/mL at start of treatment (barely detectable).  By week 4, HCV viral load undetectable.  By week 7, jaundice, abdominal pain, other signs of severe viral hepatitis developed with HBV DNA at 22 million.  HCV treatment was stopped, HBV treatment with tenofovir + emtricitabine was started.  By week 28, pt was well and both viruses were undetectable.
Patient 2: HBV viral load monitored from onset of treatment.  HBV undetectable at onset of treatment, but rose to 11,255 IU/mL by week 4.  Pt asymptomatic, but tenofovir was added to regimen.  Both viruses undetectable at week 12.
Conclusion:  Previously, interferon-based treatments of HCV were seldom complicated by HBV flares because of activity against both.  However, new HCV agents do not act against HBV.  Raises question of whether HBV treatment should be started in co-infected patients.
Clin Infect Dis 2015 Oct 15; 61:1304

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