Multiple hepatitis virus infections in chronic HBsAg carriers in Naples

Abstract

In order to determine the prevalence of multiple infections with hepatitis viruses in chronic HBsAg carriers in Naples, to assess the interaction between HBV, HDV and HCV infections and to evaluate the influence of multiple virus hepatitis infections on the clinical presentation, we studied 198 HBsAg chronic carriers observed consecutively from 1971 to 1988 at our Liver Unit. Of the 198 HBsAg chronic carriers, 171 had undergone percutaneous liver biopsy. The presence of HBcAg or HDAg in the liver biopsy was considered a marker of HBV or HDV replication, respectively; the presence of anti-HCV was considered a marker of HCV infection. Anti-HCV was observed in 13.6% of the 22 subjects with normal liver, in 27.7% of the 47 patients with minimal chronic hepatitis, in 40% of the 50 with mild chronic hepatitis, in 70.6% of the 17 with moderate hepatitis, in 66.7% of the 3 with severe chronic hepatitis and in 65.6% of the 32 with active cirrhosis. Anti-HCV positive cases were antiHD positive more frequently than the anti-HCV negative (59.2% vs. 43%, p = 0.05). HDV infection exerted a clear inhibition on the HBV genome. Among the 171 HBsAg chronic carriers, the finding of an active chronic hepatitis (moderate chronic hepatitis + severe chronic hepatitis + active cirrhosis) is less frequent in subjects with HBV replication alone than in those with HDV replication or HCV infection. Patients with both HBV replication and HCV infection and those with both HDV replication and HCV infection showed a very high prevelance of active chronic hepatitis.

Virologic and Clinical Expressions of Reciprocal Inhibitory Effect of Hepatitis B, C, and Delta Viruses in Patients With Chronic Hepatitis

“…Consistent with the data reported here are those from studies by Mohamed and Al Karawi, 21 Zarski et al, 24 and ourselves, 10 who report higher prevalences of cases with histologically proven severe chronic hepatitis and liver cirrhosis among patients with chronic hepatitis from a dual HBV ϩ HCV infection than from HCV infection alone. Thus, despite the reciprocal inhibition between the hepatitis viruses, patients with coinfection more frequently had severe liver disease and showed a higher serum transaminase level.…”

“…However, small pilot studies have prompted the hypothesis that HCV may have an inhibitory effect on HBV replication [15][16][17][18][19] and that multiple HBV and HCV infection may be associated with a more severe clinical presentation. 10,[20][21][22][23][24][25] The interaction between HDV and HCV in hepatitis B surface antigen (HBsAg) chronic carriers has not as yet been investigated.In this article we report the data from an Italian multicenter case-control study with incident cases, performed on a high number of patients with chronic hepatitis from a multiple hepatitis virus infection who were compared with patients with chronic hepatitis caused by a single virus. We investigated the interference between viruses, the clinical impact of a multiple virus infection compared with a single HBV or HCV infection, and tested the hypothesis that anti-HCV-positive/ anti-hepatitis B core antigen (HBc)-positive patients lacking both HBsAg and anti-hepatitis B surface antigen (HBs) might be a subgroup of patients with a multiple HBV and HCV infection.…”

“…However, small pilot studies have prompted the hypothesis that HCV may have an inhibitory effect on HBV replication [15][16][17][18][19] and that multiple HBV and HCV infection may be associated with a more severe clinical presentation. 10,[20][21][22][23][24][25] The interaction between HDV and HCV in hepatitis B surface antigen (HBsAg) chronic carriers has not as yet been investigated.…”

“…9 The prevalence of patients with HCV and HBV coinfection has been described as high in geographic areas where a high endemic level of both infections is reported, such as Western Asia and the Mediterranean Basin. [10][11][12][13][14] The interaction between HCV and HBV has so far been poorly investigated. Little is known on the clinical presentation, the natural history, and the response to antiviral treatment of liver diseases associated with HBV and HCV coinfection.…”

Ribavirin and interferon is effective for hepatitis C virus clearance in hepatitis B and C dually infected patients

“…3 In Italy, the prevalence of anti-HCV positivity can be as high as 40% in patients with chronic hepatitis B. 6 Alarmingly, the HCV and HBV coinfected patients have been shown to carry a much higher risk of developing cirrhosis or hepatocellular carcinoma than those with HCV or HBV infection alone. 4,7,8 At present, treatment with interferon alfa (IFN-␣) in combination with ribavirin clears HCV in about 30% to 60% of patients with simple chronic hepatitis C. [9][10][11][12][13] Unfortunately, current therapeutic targets and ongoing protocols of clinical trials recruit patients with HCV infection only and invariably exclude those coinfected with HBV.…”