Sustained hepatitis C virus clearance and increased hepatitis B surface antigen seroclearance in patients with dual chronic hepatitis C and B during posttreatment follow-up

Abstract

Patients dually infected with hepatitis C virus (HCV)/hepatitis B virus (HBV) have a higher risk of developing advanced liver disease or hepatocellular carcinoma compared with monoinfected patients. Yet, there is a similar rate of sustained virologic response (SVR) after peginterferon alfa-2a and ribavirin combination therapy in these patients compared with HCVmonoinfected patients and a high hepatitis B surface antigen (HBsAg) seroclearance rate. The durability of hepatitis C and B clearance in coinfected patients was investigated in a 5-year follow-up study. Patients with active HCV genotype 1, both HBV-coinfected (n 5 97) and HBVmonoinfected (n 5 110), underwent 48-week combination therapy with peginterferon alfa-2a plus ribavirin. In patients with active HCV genotype 2 or 3, both HBV-coinfected (n 5 64) and monoinfected (n 5 50) patients underwent 24-week combination therapy. A total of 295 (91.9%) patients completed treatment and 24 weeks posttreatment follow-up; 264 (89.5%) patients agreed to receive additional follow-up for up to 5 years after the end of treatment. After a median follow-up of 4.6 6 1.0 years, six of the 232 patients achieving SVR developed HCV RNA reappearance, including five HCV genotype 1/HBV-coinfected patients and one HCV genotype 2/3-monoinfected patient. Subgenomic analysis of the HCV core gene indicated that five patients developed delayed recurrence of HCV infection. Overall, the cumulative recurrence rate of HCV infection was 2.3% (0.4%/year; 95% confidence interval [CI], 0.9%-5.5%). The cumulative HBsAg seroclearance rate was 30.0% (95% CI, 21.5%-42.0%); with 33.1% (95% CI, 21.8%-50.1%) in the 48-week combination therapy group and 24.3% (95% CI, 13.7%-42.9%) in the 24-week therapy group. Conclusion: Peginterferon alfa-2a and ribavirin therapy provides good HCV SVR durability and a high accumulative HBsAg seroclearance rate in patients who are coinfected with HCV and HBV. (HEPATOLOGY 2013;57:2135-2142

Coinfection With Hepatitis B and Hepatitis C Virus: New Insights of Treatment in the Era of Direct Acting Antivirals.

“…[31] Indeed, studies reported 11.2% (18/161) HBsAg loss 6 months after the end of treatment and HBsAgseroclearance rate of 5.4% per year in HBV/HCV coinfected patients. [41], [42] Baseline low serum HBsAg levels correlated significantly with HBsAgseroclearance. Another study [56] showed that the host genetic polymorphism rs9277535 for HLA-DPB1 region was associated with spontaneous HBsAgseroclearance.…”

“…Also, the same authors investigated the sustained HCV clearance both in patients with HCV/HBV coinfection and HCV infection alone for a follow-up period of 5-years. [41] They reported that HCV reappearance occurred only in 6 (2.6%) of the 232 patients who achieved SVR and concluded that sustained HCV clearance is not influenced by HBV coinfections.…”

APASL consensus statements and recommendations for hepatitis C prevention, epidemiology, and laboratory testing

“…The traditional primary endpoint of assessing anti-HCV therapy is SVR24 (HCV RNA \50 IU/mL 24 weeks after end of treatment), which indicates that HCV RNA remains negative during long-term follow-up [173]. Recent studies demonstrated that SVR12 (HCV RNA \25 IU/mL 12 weeks after end of treatment) had positive predictive values (PPV) of [98 % for SVR24, regardless of whether therapy was interferon based or DAA interferon free [174,175].…”

Nanomedicines in the treatment of hepatitis C virus infection in Asian patients: optimizing use of peginterferon alfa

“…3,4 Compared to the development of conventional interferon alpha (IFN α) for the treatment of chronic HCV infection, which results in only 6%-19% of SVR after 24-48 weeks of treatment, the use of peginterferon alfa (PEG-IFN α) in combination with ribavirin (RBV) has greatly improved the overall SVR rate to 42%-52% in HCV genotypes 1/4 patients and 76%-82% in HCV genotype 2/3 patients, respectively. [5][6][7] In addition, the introduction of response-guided therapy (RGT), where the optimized treatment duration is on the basis of early viral kinetics during the first 12 weeks of treatment, has further increased the SVR rate to 70%-75%.…”

“…[20][21][22][23][24][25] With the use of IFN-based therapy to treat HCV infection, many studies have indicated that more than 98% of patients who achieve SVR have durable undetectable serum HCV RNA by long-term post-treatment follow-up. 3,4 Patients with SVR have improved liver histology on necroinflammation and fibrosis, as well as decreased liver-related mortality, hepatic decompensation, and HCC. 26,27 Furthermore, successful antiviral treatment may have beneficial clinical outcomes even for HCV-infected patients with decompensated cirrhosis.…”