Hepatitis C Management:
Management of Special Groups:
|Print Monograph (pdf)|
HCV-infected individuals with serologically silent HBV infection may have more severe liver disease and an elevated risk of liver cancer.
Treatment decisions in HCV-HBV coinfection must be individualized.
The clinical course of hepatitis C is believed to be worsened by HBV coinfection. On the other hand, it has been suggested that active HBV infection suppresses the replication of HCV. Reports show that serologic and histopathologic data from a large group of anti-HCV-positive patients found a significantly lower prevalence of HCV RNA (41%) in those with active HBV infection (hepatitis B surface antigen [HBsAg]-positive) than in those who had already recovered from HBV infection (82%) (HBsAg-negative/anti-hepatitis B core [HBc]-positive).130 This suggests that active HBV coinfection, but not previous HBV infection, is associated with decreased replication of HCV RNA. Patients with chronic HCV infection and active HBV coinfection experience more severe liver damage as seen on biopsy than do those who have HCV infection alone. They also have a higher risk for the development of liver cancer.131
Two entities are seen in clinical practice: serologically silent HBV infection and active HBV infection.
Recent studies have shown that the presence of serologically silent HBV coinfection (eg, HBsAg/anti-HBs-negative patients with positive anti-HBc and HBV DNA) in patients with chronic HCV infection worsens the severity of liver disease. Histologic fibrosis scores are higher in anti-HBc-positive patients with HCV infection than in anti-HBc-negative patients with HCV infection. This, together with a poor response to IFN in patients with serologically silent HBV coinfection, is thought to be due partly to down-regulation of IFN receptor gene expression in the liver. Early data suggest that integrated HBV DNA may be important to the development of hepatocellular carcinoma in HCV-positive/HBsAg-negative patients who carry the anti-HBc antibody.131
In patients with HCV infection who have evidence of active HBV infection (hepatitis B envelope antigen [HBeAg]-positive), it appears reasonable to treat the two infections concurrently with a PEG-IFN-based regimen, in light of evidence that PEG-IFN also appears to be effective against active HBV infection.132 However, no clinical trials have been conducted to specifically assess treatment efficacy in the HCV/HBV-coinfected population.