Serologically silent hepatitis B virus coinfection in patients with hepatitis C virus-associated chronic liver disease: Clinical and virological significance

Abstract

Frequent coinfection of surface antigen-negative hepatitis B virus (silent HBV) in hepatitis C virus (HCV)-associated chronic liver disease (CLD) has been reported. The clinical and virological significance of silent HBV infection was investigated in 65 patients with HCV-associated CLD who subsequently received interferon (IFN) therapy. HBV DNA was detected in 34 (52.3%) patients by a nested polymerase chain reaction (PCR). Virologically, all of the 34 patients were found to have HBV with an eight-nucleotide deletion in the core promoter. Coinfection of silent HBV was more frequent with HCV genotype 1b than in 2a (64.3% vs. 28.6%, P<.01). With HCV genotype 1b, the serum RNA level was significantly higher (> or =10(6) copies per milliliter vs. < or =10(5) copies per milliliter) in patients with silent HBV than those without coinfection (P<.01). Clinically, silent HBV was associated with a higher level of serum alanine aminotransferase (158.5+/-104.8 vs. 121.8+/-78.6 IU/I; mean +/- SD) and a greater histological activity of hepatitis as evaluated by histological activity index score (9.4+/-3.8 vs. 8.6+/-4.5; mean +/- SD), although it was not statistically significant. Silent HBV was also associated with poor efficacy of IFN therapy (P<.01). The results suggest that silent HBV has some promoting effect for HCV replication, at least for HCV genotype 1b, and may affect the histological activity of hepatitis and IFN response in HCV-associated CLD.

Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil

“…In contrast, HBV DNA has been found in serum by PCR in 6.7% to 52% (13,15,16) of HBsAg-negative patients with chronic HCV infection, in 5% to 76% (7,10,30) of patients with chronic liver disease of no defi ned etiology, and in 0% (15) to 15% (21) of healthy donors.…”

“…MARISCAL et al (28) suggesting that the presence of HBV inhibits HCV replication. Nevertheless, the fi ndings about HCV viral load in the presence of HBV reported in the literature are confl icting (9,12,13,40) .…”

“…The prevalence of co-infection, is about 15%-30%, and 40%-50% when serum and liver tissue are tested, respectively (7,9,13,15,36) and differs with sensibility of test used.…”

“…Despite evidence that co-infection may accelerate the progress to liver disease (9,41) , be related to the emergence of HCC (34,37,38) , and adversely infl uence the response to HCV treatment (7,9,13,41) , other studies show that occult infection does not interfere with the natural history of the disorder in this population (12,15,16,22) .…”

Occult hepatitis B virus infection in immunocompromised patients

“…Occult HBV infection has received much attention recently, since it has been detected in patients with hepatocarcinoma [18], in blood donors and transfused patients [19,20], and in patients infected with hepatitis C virus [21][22][23]. In chronic HCV patients on hemodialysis, the prevalence of occult HBV infection is not yet well known [22,24].…”