Hepatitis B Virus Infection Among American Patients With Chronic Hepatitis C Virus Infection: Prevalence, Racial/Ethnic Differences, and Viral Interactions

Abstract

Little is known about hepatitis B virus (HBV) infection among patients with chronic hepatitis C virus (HCV) infection in the UnitedStates. We prospectively enrolled 1,257 patients with chronic HCV infection from two medical centers in New York City. A total of 61.5% (95% confidence interval, 58.8%-64.2%) had evidence of prior exposure to HBV (hepatitis B core antibody-positive), whereas 5.8% (95% confidence interval, 4.5%-7.1%) had dual infection with HBV (hepatitis B surface antigen-positive). Multivariable logistic regression analysis identified age <40 years, Asian race, injection drug use, and a greater number of lifetime sexual partners as independent risk factors for HBV-HCV dual infection. Liver biopsy results in 26 HBV-HCV-infected and 658 HCV-monoinfected patients showed that stage 3 or 4 fibrosis was significantly more common in those with HBV-HCV dual infection (84.6% versus 29.9%; P < 0.001). Patients infected with HBV and HCV had significantly lower median HCV RNA levels (1.3 versus 4.5 ؋ 10 6 copies/mL; P < 0.001) and were less likely to have HCV RNA levels >5 ؋ 10 6 copies/mL (12.3% versus 45.4%; P < 0.001) than those who had HCV monoinfection. All five patients with HBV-HCV dual infection who had undetectable HBV DNA levels had HCV RNA levels >5 ؋ 10 6 copies/mL. Conclusion: American patients with chronic HCV infection should be tested for HBV, especially younger patients, Asians, injection drug users, and those with an increased number of lifetime sexual partners. The presence of severe liver disease and HBV-HCV viral interactions in patients with dual infection necessitates careful but aggressive clinical management, although the optimal strategy remains to be determined. (HEPATOLOGY 2010;51:759-766.)

A Brief Update on the Treatment of Hepatitis C

“…Around 2-10% of patients with chronic HCV are coinfected with HBV [34][35][36]. It has been shown that the presence of HBV coinfection with HCV accelerates the progression of liver damage, and is associated with a higher probability of liver cirrhosis and hepatic decompensation, higher incidence of hepatocellular carcinoma, and death [36,37].…”

The Role of Monocytes/Macrophages in HBV and HCV Infection

“…Given their similar modes of transmission, HBV/HCV co-infection occurs frequently in endemic areas although its prevalence is exactly unknown [67]. Between 2 and 10% of anti-HCV-positive patients also test positive for HBsAg, while 5-20% of patients with chronic HBV infection test positive for anti-HCV antibodies [68]. It has been reported that HBV/HCV coinfection leads to more severe liver disease and a higher prevalence of liver cancer than noninfection [69], but an inverse relationship between the replication of each virus within some co-infected patients has been noted [70][71][72][73][74].…”

Risk of HBV Reactivation in Patients Infected with HBV/HCV Treated with DAA

“…In Bini et al observations, 61.5% of 1,257 patients with chronic HCV infection had evidence of prior exposure to HBV, whereas 5.8% had dual infection with HBV (7). The incidence of the presence of isolated anti-Hepatitis B core antibodies (HBcAb) in HCV infected patients may be higher because screening programs require often only test for HBsAg (3,7). According to Wang et al study, the prevalence of occult HBV infection (OBI) defined as the presence of HBV DNA in the absence of HBsAg has been estimated from 11.9 to 44.4% of HCV infected cases (8)…”