INHIBITION OF HIGH FITNESS VIRUSES BY DIFFERENT ANTIVIRAL STRATEGIES WHEN THE INFECTION HAS STARTED

Background and aims: Hepatitis B virus (HBV) reactivation may occur in chronic hepatitis C (CHC) coinfected patients using directacting antivirals (DAAs).However, previous studies have reported inconsistent findings on this issue.We investigated the association between DAA and HBV reactivation by conducting a meta-analysis.Method: Relevant studies were identified by searching Medline, EMBASE, Cochrane Central Register of Controlled Trials, KoreaMed, KMbase, and RISS to September 4 th , 2020.The primary outcome was HBV reactivation.Random effect method was used for pooling the data.Results: We identified 39 articles, comprising 119, 484 patients with chronic (n = 1, 673) or resolved (n = 13, 497) HBV infection who treated with DAA.When all studies were pooled, the rate of HBV reactivation was 12% (95% confidence interval (CI) 0.06-0.19).When stratified by baseline HBV DNA, undetectable HBV DNA (HBV DNA <20 IU/ml) group showed significantly lower risk of reactivation compared to detectable HBV DNA group (odds ratio (OR) 0.30, 95% CI 0.11-0.86).Although patients on prophylactic anti-HBV therapy showed a lower reactivation rate, there was no significant difference (OR 0.27, 95% CI 0.07-1.01).The rate of HBV reactivation was only 0.4% in patients with resolved HBV infection. Conclusion:The risk of HBV reactivation was not negligible in HCV coinfected patients using DAAs, indicating watchful attention for HBV reactivation is still needed.