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Hepatitis B virus reactivation: case report An approximately 73-year-old woman developed hepatitis B virus reactivation during treatment with sofosbuvir and ribavirin for hepatitis C infection. The woman, who had a history of gastrointestinal ulcer, was found to be infected with hepatitis C virus infection in 1996 at the age of 53-years. She had no family history of hepatitis B virus infection. In 1997, antibody against hepatitis B surface antigen (anti-HBs) and hepatitis B surface antigen (HBsAg) were negative, but antibody against HBV core (anti-HBc) was positive. In 2001, she developed malignant lymphoma at the age of 58-years. She had received pirarubicin [pirarubicin hydrochloride], ciclosporin, vincristine [oncovin] and prednisolone. The next year, she had undergone autologous peripheral blood stem cell transplantation. In 2014, anti-HBs and HBsAg were negative, but anti-HBc remained positive. In October 2015, she started receiving treatment with sofosbuvir 400 mg/day and ribavirin 600 mg/day [routes not stated]. Four weeks after initiation of sofosbuvir and ribavirin, the hepatitis C RNA was negative. She continued receiving sofosbuvir and ribavirin for 12 weeks without any adverse event. Twenty-four weeks after discontinuation of sofosbuvir and ribavirin, she achieved sustained virological response. At the time, serum hepatitis B virus DNA level was negative. Thirty-nine weeks after discontinuation of sofosbuvir and ribavirin (at an approximate age of 73-years), liver enzymes elevated without any physical examination findings and symptoms. Serum hepatitis B-DNA level increased to more than 9.1 LogIU/mL and HBsAg became positive. The hepatitis B virus strain (HB16-1360) found to be genotype A. Ultrasound sonography and abdominal CT scan showed chronic changes in the liver without ascites or liver atrophy consistent with hepatitis B virus reactivation secondary to the sofosbuvir and ribavirin use. The woman received treatment with entecavir for suspected acute hepatitis caused by hepatitis B virus reactivation. Forty-three weeks after discontinuation of sofosbuvir and ribavirin, liver biopsy was performed, which revealed no findings suggestive of positive Victoria blue staining in hepatocytes or self-limited acute hepatitis. After treatment with entecavir, her liver function improved. Six months after treatment with entecavir, the serum hepatitis B DNA level decreased to 3.6 LogIU/mL. Miyasaka A, et al. Hepatitis B virus reactivation after successful treatment of hepatitis C virus with sofosbuvir and ribavirin: A case report and literature review. [Review]. 803515532 Medicine 99: No. 41, 9 Oct 2020. Available from: URL: http://doi.org/10.1097/MD.0000000000022650

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Reactions 21 Nov 2020 No. 1831