Clinical features and treatment efficacy of peginterferon alfa plus ribavirin in chronic hepatitis C patients coinfected with hepatitis B virus

Abstract

Background/AimsCross-sectional studies have documented that 2-10% of patients who are chronically infected with hepatitis C virus (HCV) are also positive for hepatitis B virus (HBV) surface antigen (HBsAg). Data related to HCV-HBV coinfection are lacking in Korea. This study evaluated the clinical characteristics, the treatment efficacy of peginterferon alfa plus ribavirin, and the changes induced by such treatment in HBV status in chronic hepatitis C (CHC) patients coinfected with HBV.MethodsEighteen (2.37%) HBsAg-positive CHC patients were selected from among the 758 subjects from the K(G)yeonggi-Incheon Peginterferon alfa and ribavirin in chronic hepatitis C Treatment (KIPECT) study, which evaluated the treatment efficacy and safety of peginterferon alfa plus ribavirin in CHC patients. Data on changes in the status of HBV infections were obtained.ResultsHCV genotype 1b was the most common (44%). The overall sustained virologic response rate was 72% in all patients, and 60% and 87.5% in genotypes 1 and 2, respectively. Two of the 18 patients were positive for HBeAg, and 15 had baseline HBV DNA level of less than 2,000 IU/mL. Two of the three whose levels exceeded this threshold showed no detectable DNA after treatment. After the completion of treatment, serum HBV DNA levels were increased in the two patients whose baseline HBV DNA levels were less than 2,000 IU/mL.ConclusionsThe prevalence of HBV coinfection in CHC patients was 2.37% and most of the patients were inactive carriers. The treatment efficacy was similar to that of HCV mono-infection. Reactivation of HBV replication was observed in some patients after CHC treatment.

Efficacy of Treatments for Patients with Chronic Liver Disease due to Coinfection with Hepatitis B and C Viruses

“…In patients with HBV/HCV coinfection who were treated with IFN/RBV combination therapy, the SVR rate of HCV was reportedly the same as that of patients with HCV monoinfection [1,21,22,27,[31][32][33], regardless of the HCV genotypic differences (genotype 1 or 2/3) [34]. Moreover, Yu et al [34] reported that in patients with HBV/HCV coinfection who achieved an SVR of HCV after treatment with PEG-IFN/RBV combination therapy, the rate of HCV-RNA recurrence after treatment was 2.3% (0.4% every year).…”

“…However, other authors using the same in vitro examination techniques later reported that HBV and HCV could replicate in the same hepatocyte without any evidence of interference effects [2,20,21]. Moreover, early clinical studies suggested that in HBV/HCV coinfection, HBV proliferation was inhibited by HCV [1,[22][23][24][25], and conversely, HCV proliferation was inhibited by HBV [1,26]. However, in most coinfection cases, HCV is predominant and HBV is inactive [1,17,22,23], although there are regional differences worldwide [12].…”

“…Moreover, early clinical studies suggested that in HBV/HCV coinfection, HBV proliferation was inhibited by HCV [1,[22][23][24][25], and conversely, HCV proliferation was inhibited by HBV [1,26]. However, in most coinfection cases, HCV is predominant and HBV is inactive [1,17,22,23], although there are regional differences worldwide [12]. Furthermore, in patients with HBV/HCV coinfection, a shift in the predominant virus may occur during the infection period [27].…”

“…Flares and HBV reactivation were observed in approximately one-third of patients [1,12,22,28,37]. However, it has also been reported that patients with HBV reactivation usually do not develop clinically apparent hepatitis [34], although Yalcin et al [38] reported a case of severe hepatitis induced by a flare of HBV in an HBV/HCV coinfected patient receiving IFN/RBV.…”

“…In addition, serum HBsAg titers are useful as a predictor of the efficacy of IFN therapy [34,37,42]. Because of the interference effect of HCV on HBV, most patients with coinfection have low HBsAg titers, and serum HBV-DNA levels often decrease, which may be one of the reasons why HBsAg clearance can be easily achieved after treatment [25,22,37]. Gordon et al [9] reported that only low pretreatment serum HBsAg titers are correlated with post-treatment HBsAg clearance or sustained antigen seroconversion on multivariate analysis.…”