Clonorchis sinensis Co-infection Could Affect the Disease State and Treatment Response of HBV Patients

Abstract

BackgroundClonorchis sinensis (C. sinensis) is considered to be an important parasitic zoonosis because it infects approximately 35 million people, while approximately 15 million were distributed in China. Hepatitis B virus (HBV) infection is a major public health issue. Two types of pathogens have the potential to cause human liver disease and eventually hepatocellular carcinoma. Concurrent infection with HBV and C. sinensis is often observed in some areas where C. sinensis is endemic. However, whether C. sinensis could impact HBV infection or vice versa remains unknown.Principal FindingsCo-infection with C. sinensis and HBV develops predominantly in males. Co-infected C. sinensis and HBV patients presented weaker liver function and higher HBV DNA titers. Combination treatment with antiviral and anti-C. sinensis drugs in co-infected patients could contribute to a reduction in viral load and help with liver function recovery. Excretory-secretory products (ESPs) may, in some ways, increase HBV viral replication in vitro. A mixture of ESP and HBV positive sera could induce peripheral blood mononuclear cells (PBMCs) to produce higher level of Th2 cytokines including IL-4, IL-6 and IL-10 compared to HBV alone, it seems that due to presence of ESP, the cytokine production shift towards Th2. C. sinensis/HBV co-infected patients showed higher serum IL-6 and IL-10 levels and lower serum IFN-γ levels.Conclusions/SignificancePatients with concomitant C. sinensis and HBV infection presented weaker liver function and higher HBV DNA copies. In co-infected patients, the efficacy of anti-viral treatment was better in patients who were prescribed with entecavir and praziquantel than entecavir alone. One possible reason for the weaker response to antiviral therapies in co-infected patients was the shift in cytokine production from Th1 to Th2 that may inhibit viral clearance. C. sinensis/HBV co-infection could exacerbate the imbalance of Th1/Th2 cytokine.

Human liver flukes

“…Severin, an excretory/secretory product of Clonorchis sinensis inhibits apoptosis of HCC cell lines in vitro (48) . Co-infection with C. sinensis in chronic hepatitis B infection, has been shown to be associated with higher hepatitis B virus (HBV) DNA titres (76) .…”

High prevalence of Clonorchis sinensis infections and coinfection with hepatitis virus in riverside villages in northeast China

“…Xu's study indicated that the C . sinensis /HBV co-infection group presented decreased liver function and increased HBV DNA copies 24 . However, these results were not observed in our research.…”

“…We compared the results of laboratory examinations between the co-infection group and mono-infection group and found that the results of laboratory examinations in the C. sinensis/HBV group were similar to those in the C. sinensis and HBV mono-infection groups. Xu's study indicated that the C. sinensis/HBV co-infection group presented decreased liver function and increased HBV DNA copies 24 . However, these results were not observed in our research.…”

Clonorchis sinensis infection and co-infection with the hepatitis B virus are important factors associated with cholangiocarcinoma and hepatocellular carcinoma

“…This study showed that co-infection of HBV and C . sinensis could weaken liver function and promote HBV proliferation (Li et al 2016 ). The risk factors for HBV-related HCC include host factors, viral factors and liver factors (Yang et al 2011 ; Wong and Wong 2013 ; Wong et al 2010 ).…”