Relevance of inapparent coinfection by hepatitis B virus in alpha interferon-treated patients with hepatitis C virus chronic hepatitis

Abstract

The aim of the study was to investigate whether an "inapparent" coinfection by hepatitis B virus (HBV) in anti-HCV-positive chronic liver disease patients may influence interferon (IFN) response. Fourteen anti-HCV-positive, hepatitis B surface antigen (HBsAg)-negative but serum HBV-DNA-positive patients and 111 anti-HCV-positive, HBsAg-negative, and HBV-DNA-negative patients with chronic hepatitis were treated with 3 MU of recombinant alpha-2a IFN 3/week for 1.2 months. Serum HBV-DNA and HCV-RNA were determined before treatment, after 6-12 months, and at the time of alanine aminotransferase (ALT) flare-up by HBV polymerase chain reaction (PCR) and HCV PCR, respectively. IgM anti-HBc were tested using the IMx Core-M assay (Abbott Laboratories, North Chicago, IL). By the end of treatment, ALT values had become normal in 4/14 HBV-DNA-positive patients (28%), but all "responders" (4/4) relapsed. IgM anti-HBc was detected both before treatment and during ALT elevation in three patients and only during ALT relapse in another three. In the remaining 111 patients, a biochemical response to IFN treatment was observed in 54% and relapse of ALT values in 47%. "Inapparent" HBV/HCV coinfection may be implicated in cases of resistance to IFN. HBV replication and HBV-related liver damage may persist in patients in whom HCV replication was inhibited by current doses of IFN, as suggested also by the presence of IgM anti-HBc in some cases. Further studies will show the effect of different treatment schedules. HBV-DNA and/or IgM anti-HBc detection with very sensitive methods may be important both as a prognostic factor and as a tool for better understanding of intervirus relationships and mechanisms involved in multiple hepatitis virus infections.

Hepatitis B Virus and Hepatitis C Virus Co-infection: An Evaluation of Eighty-Two Patients

“…The rate of HBV/HCV co-infection was found to be more common in patients over 50 years of age and increased with age in an Italian study (18). These numbers may not reflect the truth, as both were not large-scale studies and concealed infections have not been well-recognized (occult HBV infection) (19). Data related to HCV/HBV co-infection are lacking in Turkey.…”

Impact of past HBV exposure on virological response to combined interferon ribavirin therapy in patients with chronic HCV genotype 4

“…The outcome of therapy may be influenced by a dynamic complex relationship that exists between the pharmacological characteristics of the therapeutic regimen, viral kinetics, and host immune responses, or concurrent co-infection with HBV. It was observed that the presence of markers indicating past HBV infection (anti HBV antibodies) was associated with a reduced rate of treatment response [23] , in more recent study past history of HBV infection had no influence on the efficacy of treatment with IFN-alpha and ribavirin through Clearance of HCV from serum and from PBMC [34].…”

“…Moreover, some patients who are HBsAg negative but hepatitis B core antibody (anti-HBc) positive are usually regarded as having occult HBV infection [20,21]. Some investigators have suggested that occult (in apparent) HBV infection correlates with a lack of response to interferon treatment in patients with chronic hepatitis C [22,23].…”

Hepatitis B

“…HBV and HCV co-infection: 3 MU t.i.w. for 12 mo [30]. If HCV is the dominant virus, then add ribavirin.…”