HBV/HCV dual infection impacts viral load, antibody response, and cytokine expression differently from HBV or HCV single infection

Abstract

Hepatitis B virus/hepatitis C virus (HBV/HCV) dual infection is common among high-risk individuals. To characterize the virological and immunological features of patients with HBV/HCV dual infection, we enrolled 1,049 individuals who have been identified as injection drug users. Patients were divided into single and dual infection groups according to the serological markers. We found the average HCV RNA level was significantly lower; however, HBV viral load was significantly higher in HBV/HCV dual-infected patients (n = 42) comparing HCV single infection (n = 340) or HBV single infection (n = 136). The level of anti-HBs in patients who experienced spontaneous HBV clearance was higher than that in HCV single-infected patients with HBV spontaneous clearance. The level of anti-HCV E2 in HBV/HCV dual infection was lower than that detected in HCV single infection. Serum levels of IL-6, IL-8, and TNF-α were significantly lower in HBV/HCV dual-infected patients than in patients infected with HBV or HCV alone. Taken together, two viral replications are imbalanced in dual infected patients. The anti-HBs and anti-HCV E2 antibody production were impaired and proinflammatory IL-6, IL-8, and TNF-α also downregulated due to dual infection. These findings will help further understanding the pathogenesis of HBV/HCV dual infection.

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

“…In contrast, anti-E2 antibody frequency and levels were found to be lower in the context of HCV/HBV coinfection compared to HCV monoinfection in two other studies (116). …”

“…Many studies report that HCV is the dominant virus with relative suppression of HBV replication (111–115). In contrast, other studies have found that HBV is more dominant, or that there is no dominant virus with reciprocal inhibition compared to either virus monoinfection (116–121), and one other study showed higher HCV RNA clearance rates in coinfection compared to HCV monoinfection (74% vs. 14%) (122). However many of these studies are largely cross-sectional with only one time point for HCV and HBV testing, and may explain the widely varying clinical presentations described.…”

“…Chen et al , demonstrated that levels of the proinflammatory cytokines IL-6, IL-8 and TNF-α were lower compared to monoinfection with either virus (116). These results were consistent with previous in vitro data demonstrating that dendritic cells increased production of anti-inflammatory cytokines such as IL-10 when co-cultured with HBV and HCV proteins, which in turn inhibits the production of profinflammatory cytokines (125).…”

HBV coinfection with HCV alters circulating Tfh cell distribution and impairs HCV neutralizing antibody responses

“…Whether and how these viruses interfere reciprocally may dependent on the infection order and disease stage. Of note, we and other colleagues showed that HCV replication was suppressed during HBV/HCV coinfection compared with HCV monoinfection . In this cohort, we also found the fact that HBV replication dominates during HBV/HCV coinfection (data not shown), and it may partially explain altered distribution of cTfh subsets within HBV/HCV coinfection distinct from HCV monoinfection.…”

Hepatitis B and C coinfection in a real-life setting: viral interactions and treatment issues

“…In Greece, as in most countries with intermediate endemicity for HBV infection, most of these infections occurred through horizontal transmission during infancy or early childhood; thus, patients had HBV infection for many years before being infected by HCV. As proposed by Chen et al , patients who acquired HCV infection later than HBV infection have a minority of hepatocytes uninfected by HBV and thus “available” for HCV superinfection; this unequal distribution of the coinfection leads to HBV dominance [ 15 ].…”