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.

The influence of occult infection with hepatitis B virus on liver histology and response to interferon treatment in chronic hepatitis C patients

“…Occult HBV infection in HCV-infected patients has been suggested as a possible co-factor, responsible for both impaired response to interferon therapy [13,18] and more severe liver disease [11,17,45,46].…”

“…A reduced response to interferon therapy has been described in individuals with chronic hepatitis C and serological markers of a resolved HBV infection (HBsAg negative/anti-HBc positive), perhaps due to an inapparent HBV co-infection in these patients [18]. More recently, some authors have observed that occult HBV infection correlates with a lack of response to interferon treatment in patients with chronic hepatitis C [11,18,45]. Cacciola et al detected a virological response in 21% and 42% of HCV-positive patients who had an occult infection with HBV or not, respectively [11].…”

“…Recently, very low levels of HBV-DNA have also been identified in the sera of patients with chronic hepatitis C virus (HCV) infection, even though there is no HBsAg in the serum [11,13,[14][15][16][17][18]. It appears that this occult infection contributes to chronic liver damage and to the development of hepatocellular carcinoma [11,15,[19][20][21][22].…”

“…It appears that this occult infection contributes to chronic liver damage and to the development of hepatocellular carcinoma [11,15,[19][20][21][22]. Occult HBV infection can also be associated with a lack of response to interferon treatment in patients with chronic hepatitis C [11,18]. Recently, we used PCR to study the prevalence of occult HBV infection in serum samples of 106 patients with chronic HCV infection who were both HBsAg negative and anti-HBc positive.…”

High prevalence of occult hepatitis B in hepatitis C‐infected Egyptian children with haematological disorders and malignancies

“…Concomitant HCV and occult HBV co‐infection is a frequently encountered clinical entity in patients with chronic HCV infection of various frequencies (50–87%) (12, 22, 24–26). Coinfection may lead to a low rate of replication due to mutual interference between both viruses.…”