Hepatitis C Virus and Hepatitis B Virus Co-Infection

Abstract

<jats:p>Hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infection can be encountered in either virus endemic countries. Co-infection can also be found in populations at risk of parenteral transmission. Previous studies demonstrated a high risk of liver disease progression in patients with HCV/HBV co-infection; thus, they should be treated aggressively. Previous evidence recommended therapy combining peginterferon (pegIFN) alfa and ribavirin for co-infected patients with positive HCV RNA. Recent trials further advise using direct-acting antivirals (DAAs) for the clearance of HCV in the co-infected patients. Reactivation of HBV has been observed in patients post-intervention, with higher risks and earlier onset in those having had HCV cured by DAA- versus pegIFN-based therapy. The mechanism of HBV reactivation is an interesting but unsolved puzzle. Our recent study revealed that in vitro HBV replication was suppressed by HCV co-infection; HBV suppression was attenuated when interferon signaling was blocked. In vivo, the HBV viremia, initially suppressed by the presence of HCV super-infection, rebounded following HCV clearance by DAA treatment and was accompanied by a reduced hepatic interferon response. In summary, major achievements in the treatment of HCV/HBV co-infection have been accomplished over the past 20 years. Future clinical trials should address measures to reduce or prevent HBV reactivation post HCV cure.</jats:p>

Management and Treatment of Hepatitis C: Are There Still Unsolved Problems and Unique Populations?

“…Differently from EASL recommendations, the American Association for the Study of Liver Disease (AASLD) states that monitoring HBV DNA and ALT every 4-8 weeks for 3 months post-DAA is appropriate in co-infected patients positive for HBsAg [47]. The lack of unanimous agreement regarding the management of these patients suggests that HCV/HBV co-infected are still a special population and future studies are expected to clarify the best therapeutic approach for this cohort [6].…”

“…In this context, the presence of liver decompensation and severe renal impairment may limit treatment options [5]. Moreover, due to the risk of re-activation of hepatitis B virus (HBV) in patients with dual infections and to the risk of drug interactions in human immunodeficiency virus (HIV) co-infected individuals, careful consideration before therapy initiation is needed [6,7]. Notably, less treatment-susceptible genotypes (e.g., 1l, 4r, 3b, 3g, 6u, 6v) is an emerging challenge and DAA treatment failure involves a significant proportion of patients (approximately 1-3% of all HCV patients) [8,9].…”

Pharmacotherapeutic management of chronic viral hepatitis

“…• excessive alcohol consumption for long and constant periods of time can lead to liver cirrhosis and even liver cancer. The risk is higher for those who already have hepatitis B.who have a weakened body and damaged liver [10,12,13].…”

“…In the case of chronic hepatitis B, the role of treatment is to reduce the risk of complications, such as liver failure and cirrhosis. Specific drugs for the treatment of chronic hepatitis B are based on interferons and nucleoside/nucleotide analogues [12,13]. The drug therapy that is administered depends on the clinical form: Lamivudine 1oo mg / day, alone or in combination with Interferon alfa 2a or 2b (Intron A 2.5-5.000.000 DI 3 times / week, for 4-6 Roferon A 4.500.000 DI / week for 6 months or pegylated Interferon l80 g / week) [13].…”

“…Specific drugs for the treatment of chronic hepatitis B are based on interferons and nucleoside/nucleotide analogues [12,13]. The drug therapy that is administered depends on the clinical form: Lamivudine 1oo mg / day, alone or in combination with Interferon alfa 2a or 2b (Intron A 2.5-5.000.000 DI 3 times / week, for 4-6 Roferon A 4.500.000 DI / week for 6 months or pegylated Interferon l80 g / week) [13]. The duration of therapy is at least 3 months, up to several years, depending on the clinical and biological evolution -GPT remission, inflammatory process, circulating DNA titer.…”