Due to overlapping transmission routes, many people are coinfected with both hepatitis B and C viruses. A study published in the September 2008 Journal of Viral Hepatitis adds to the evidence that HBV and HCV seem to inhibit each other in the body. F. Tseng and colleagues enrolled 1,694 HBV/HCV coinfected injection drugs users in a cross-sectional study during 1998-2000.

Within this population, hepatitis B surface antigen (HBsAg) prevalence decreased with increasing age among those who had detectable HCV RNA (from about 5% in those aged 18-29 years to 1% for those 50 or older), but stayed the same in those with undetectable HCV. Overall, chronic hepatitis B was less common among individuals with chronic hepatitis C, and this inverse relationship was most evident in the oldest participants.

“Coinfection with HCV may enhance the resolution of HBsAg during the chronic phases of these infections,” the researchers concluded. In a related pilot study described in the November 2008 Journal of Hepatology, A. Potthoff and colleagues assessed the safety and efficacy of hepatitis C treatment in 19 patients with chronic HBV/HCV coinfection.

Ten participants had HCV genotype 1 and nine had genotypes 2 or 3; at baseline, 13 had undetectable HBV DNA, but were HBsAg positive. All patients received PegIntron plus weighted-adjusted ribavirin for 48 weeks, regardless of HCV genotype. In an intent-to-treat analysis, 14 participants (74%) achieved sustained HCV virological response and 12 (63%) experienced ALT normalization. Among 15 adherent patients who took the full course of treatment, 14 (93%) achieved SVR. Furthermore, two patients who were initially HBV DNA positive had undetectable HBV DNA at the end of follow-up, but four initially HBV DNA negative patients became HBV DNA positive after HCV clearance.

The researchers concluded that, “Combination therapy with [Pegintron] and ribavirin is highly effective in inducing a virological response concerning HCV in patients with HBV/HCV coinfection.” However, they added, “HBV replication may increase after the clearance of HCV, and thus close monitoring for both the viruses is recommended even in patients with initially undetectable HBV DNA.”

Thanks to HCV Advocate for this information:

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