Hepatitis B reactivation after HCV treatment with sofosbuvir/ledipasvir in a HIV-coinfected patient with previous positive anti-HBs antibody: a case report and a review of literature

Chronic hepatitis B (HBV) and C (HCV) coinfection are frequently observed in clinical practice. The interaction between HCV and HBV is complex and not completely understood, and usually results in the suppression of hepatitis B replication by HCV superinfection or coinfection. Cases of hepatitis B reactivation during and after HCV treatment with direct acting antivirals (DDA) have been described, and it is recommended to screen all patients starting DAA therapy for HBV infection markers and to monitor those that have positive markers of HBV infection. HBs antigen (HBsAg) positivity is the main risk factor for HBV reactivation, and this phenomenon is rarer in those with “resolved” HBV infection (negative HBsAg, positive antiHBc antibody (HBcAb) and anti-HBs antibody (HBsAb) positive or negative). The authors present a case of HBV reactivation after HCV treatment with sofosbuvir/ ledipasvir that occurred in a 54-year-old male that was HIV-coinfected and had “resolved” hepatitis B infection (negative HBsAg, positive HBcAb and positive HBsAb). Our case reinforces the need to screen all patients who will start DAA therapy for hepatitis C infection, and alerts clinicians to the need to closely monitor patients with evidence of previous HBV infection no only during treatment but also after HCV treatment with DAAs.