Hepatitis B Testing Should Be Done Before and During Hepatitis C Treatment

Published on Thursday, 29 September 2016

Written by Liz HIghleyman

People considering treatment for hepatitis C should first be tested for hepatitis B virus (HBV) and monitored throughout therapy, as successful elimination of hepatitis C virus (HCV) can reactivate HBV and potentially worsen liver disease, according to recent updates to American and European hepatitis C treatment guidelines.

In people with both HBV and HCV infection, HBV DNA viral load is often low or undetectable and HCV is usually the main driver of active liver disease. Although not fully understood, the 2 viruses seem to keep each other in check. HBV could become more active, however, if HCV is cured with direct-acting antiviral (DAA) therapy.

The American Association for the Study of the Liver (AASLD) and Infectious Diseases Society of America (IDSA) included the recommendation in a September 16 update to its HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C, available at www.hcvguidelines.org.


The revised recommendation states:

All patients initiating HCV direct-acting antiviral therapy should be assessed for HBV coinfection with HBsAg, anti-HBs, and anti-HBc


For HBsAg+ patients who are not already on HBV suppressive therapy, monitoring of HBV DNA levels during and immediately after DAA therapy for HCV is recommended and antiviral treatment for HBV should be given if treatment criteria for HBV are met.



AASLD/ISDA. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. www.hcvguidelines.org. Updated September 16, 2016.

JM Pawlotsky et al (European Association for the Study of the Liver). EASL Recommendations on Treatment of Hepatitis C 2016. Journal of Hepatology, 2016 (in press).

AASLD. People with Hepatitis C Should Be Tested for Hepatitis B Before Starting Antiviral Therapies. Press release. September 16, 2016.