Management of patients infected with HBV and HCV when initiating therapy of multiple sclerosis Review article

Abstract

Hepatitis type B virus (HBV) and hepatitis type C virus (HCV) are hepatotropic viruses that cause liver disease with a varied clinical course. Patients with a resolved HBV infection carry a latent form of the virus in the nuclei of hepatocytes which is denominated covalently closed circular DNA (cccDNA). The genetic information contained therein may lead to the resumption of HBV replication in case of immunosuppression. A significant increase in HBV replication or the resumption of HBV replication after a latent period is termed HBV reactivation. This may lead to asymptomatic elevation of aminotransferases, but in some cases can manifest as severe liver injury. HBV-infected patients should be evaluated for HBV treatment. Asymptomatic HBV carriers and patients with resolved HBV infection may benefit from HBV prophylaxis. Patients who have not been infected with HBV should be vaccinated. HCV treatment is indicated in all cases. The first-line therapy consists of direct-acting agents (DAAs), due to their very high efficacy and short treatment regimens, which do not exceed 12 weeks in the majority of cases. Immunosuppressive therapy may cause HCV reactivation in patients with active HCV infection. Patients after successful DAA treatment are not at risk for HCV reactivation, but reinfection is a possibility.