The influence of hepatitis B virus on antiviral treatment with interferon and ribavirin in Asian patients with hepatitis C virus/hepatitis B virus coinfection: a meta-analysis

Abstract

BackgroundClinical and laboratory studies have indicated that coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) can suppress one another, eliciting a dominant disease phenotype. To assess whether HBV can influence the antiviral effect of treatment on HCV, we performed a meta-analysis to comparatively analyze the response to interferon plus ribavirin treatment in patients with HBV/HCV coinfection and HCV mono-infection.MethodsPublished studies in the English-language medical literature that involved cohorts of HBV/HCV coinfection and HCV mono-infection were obtained by searching Medline, Cochrane and Embase databases. Studies that compared the efficacy of treatment with interferon plus ribavirin in HBV/HCV coinfection and HCV mono-infection were assessed. End-of-treatment virological response (ETVR), sustained virological response (SVR), HCV relapse rate, and alanine aminotransferase (ALT) normalization rate were compared between HBV/HCV coinfection and HCV mono-infection patients.ResultsFive trials involving 705 patients were analyzed. At the end of follow-up serum ALT normalization rates in patients with HCV mono-infection were significantly higher than in patients with HBV/HCV coinfection (odds ratio (OR) = 0.56, 95% confidence interval (CI): 0.40–0.80, P = 0.001). The ETVR and SVR achieved in HBV/HCV coinfection patients were comparable to those in HCV mono-infection patients (OR = 1.03, 95% CI: 0.37–2.82, P = 0.96 and OR = 0.87, 95% CI: 0.62–1.21, P = 0.38, respectively). The rate of relapse for HCV or HCV genotype 1 was not significantly different between HBV/HCV coinfection patients and HCV mono-infection patients (OR = 1.55, 95% CI: 0.98–2.47, P = 0.06; HCV genotype 1: OR = 2.4, 95% CI: 1.17–4.91, P = 0.19).ConclusionsTreatment with interferon and ribavirin achieves similar ETVR and SVR in HBV/HCV coinfection and HCV mono-infection. HBV/HCV coinfection patients had distinctively lower end of follow-up serum ALT normalization.

Hepatitis B reactivation during or after direct acting antiviral therapy – implication for susceptible individuals

“…A meta-analysis of treatment outcomes following peg-IFNα plus RBV demonstrated that HBV reactivation occurred in 25% overall, and the risk was highest in individuals who did not clear HCV during therapy (odds ratio 3.36) (143). However, the majority of these cases of HBV reactivation were mild with regards to increases in HBV replication and also clinical presentation.…”

Efficacy of Treatments for Patients with Chronic Liver Disease due to Coinfection with Hepatitis B and C Viruses

“…Finally, the incidence of HBV reactivation in cases in which HCV-SVR was achieved after PEG-IFN/RBV treatment was significantly higher than that in cases in which HCV-SVR was not achieved [41]. In other words, cancellation of the interference effects of HCV may be involved in the process of HBV reactivation.…”

Caution: Reactivation of Hepatitis B during Hepatitis C Treatment with Direct-Acting Antiviral Therapy

“…Reactivation of HBV while undergoing interferon-(IFN)-based antiviral therapy in chronically infected HCV patients has been documented (2), but the exact mechanism is unclear and it is hypothesized that both host and viral factors have a significant role.…”