Primary biliary cirrhosis in HBV and HCV patients: Clinical characteristics and outcome

Abstract

AIM:To present the characteristics, management and outcome of patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infections concurrent with primary biliary cirrhosis (PBC). METHODS:Since January 2001 to September 2009, we retrospectively evaluated the medical records of all HBV (n = 1493) and HCV patients (n = 526) who are followed in our center for the presence of concurrent PBC. Seventeen patients identified with concurrent viral hepatitis and PBC (8 HCV and PBC; follow-up: 61 ± 37 mo and 9 HBV and PBC; follow-up: 57 ± 38 mo). PBC diagnosis was established if the patients met at least two of the following criteria: positivity for antimitochondrial antibody, elevated cholestatic enzymes and histological lesions of PBC. RESULTS:HCV or HBV diagnosis preceded that of PBC in most patients by many years. PBC diagnosis was based on the presence of antimitochondrial antibody and elevated cholestatic enzymes in all 17 patients, while one third (5/17; 29.4%) experienced severe pruritus many years before diagnosis. Patients with PBC and HBV were significantly younger at diagnosis of PBC compared to patients with PBC and HCV (56.1 ± 11.2 vs 68.5 ± 10.3, respectively, P < 0.05). At initial clinical and histological assessment the majority of patients were cirrhotics (10/17; 58.8%) with the group of PBC and HCV carrying the highest frequency (87.5% vs 33.3% in PBC and HBV; P < 0.05). The patients with HBV and concomitant PBC seem to have better outcome compared to those with HCV and PBC since none of the 6 non-cirrhotics with HBV and PBC developed cirrhosis during follow-up.CONCLUSION: PBC diagnosis in HBV or HCV patients is very difficult and usually delayed. Therefore, in any case, cholestasis should alert physicians to further search for PBC.

Hepatitis B virus surface proteins accelerate cholestatic injury and tumor progression in Abcb4-knockout mice

“…Remarkably, the current study demonstrates aggravation of liver disease by intracellular HBsAg accumulation without viral infection in case of simultaneous labefaction. Primary biliary fibrosis and biliary atresia with additional HBV infection has been described in clinical studies [ 24 , 25 ]. In addition, biliary diseases might even be attributed or caused by HBV infection [ 26 , 27 ].…”

Recent advances in the diagnosis and treatment of primary biliary cholangitis

“…The difficulty in identifying hepatitides C virus (HCV) and/or HBV infections in PBC patients is such that an accurate diagnosis of PBC is usually observably delayed in this particular patient cohort[71]. In PBC patients with accompanying HCV infection, impact therapy might be approved in consideration of the relevant and more serious cirrhosis[72].…”

“…In PBC patients with accompanying HCV infection, impact therapy might be approved in consideration of the relevant and more serious cirrhosis[72]. A retrospective Greek study showed that, among 1493 HBV and 526 HCV patients, 17 were confirmed as having a coexistence of viral hepatitides and PBC (8 cases of HCV and 9 cases of HBV)[71]. It is very difficult to make an exact diagnosis of PBC in HBV or HCV-infected patients, meaning that a precise diagnosis is usually delayed[71].…”

“…A retrospective Greek study showed that, among 1493 HBV and 526 HCV patients, 17 were confirmed as having a coexistence of viral hepatitides and PBC (8 cases of HCV and 9 cases of HBV)[71]. It is very difficult to make an exact diagnosis of PBC in HBV or HCV-infected patients, meaning that a precise diagnosis is usually delayed[71]. Cholestasis should therefore be an important indication of PBC for physicians[71].…”

“…It is very difficult to make an exact diagnosis of PBC in HBV or HCV-infected patients, meaning that a precise diagnosis is usually delayed[71]. Cholestasis should therefore be an important indication of PBC for physicians[71]. A study in Taiwan showed that, among 76 patients with PBC, 9 cases were confirmed as having a coexistence of HCV infection and PBC, and suffered from more serious hepatic cirrhosis on the basis of Child-Pugh ( P = 0.019) and the Model for End-Stage Liver Disease (MELD) ( P = 0.01) scores[72].…”