Due to overlapping transmission routes, people may become chronically infected with both HCV and hepatitis B virus (HBV), especially in areas where either virus is endemic.

As reported in the February 2009 Gastroenterology, C.J. Liu and colleagues evaluated interferon-based therapy for hepatitis C in HCV/HBV coinfected patients in Taiwan. The study included 321 participants with active HCV infection, 161 of whom were also hepatitis B surface antigen (HBsAg) positive.

Patients with HCV genotype 1 were treated with 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 1,000-1,200 mg/day ribavirin for 48 weeks, while those with genotype 2 or 3 received the same pegylated interferon dose plus 800 mg/day ribavirin for 24 weeks.

Participants with HCV/HBV coinfection and those with HCV alone had similar—and high—SVR rates: 72.2% vs. 77.3%, respectively, for genotype 1, and 82.8% vs. 84.0%, respectively, for genotypes 2/3. "Combination therapy with peginterferon alfa-2a and ribavirin is equally effective in patients with HCV monoinfection and in those with dual chronic HCV/HBV infection," the researchers concluded.

Since HCV and HBV appear to inhibit each others' replication, suppressing one virus can lead to worsening of the other. Here, 36.3% of the 77 coinfected patients who had undetectable HBV viral load prior to hepatitis C treatment developed detectable HBV DNA after therapy, although this was not accompanied by significant clinical symptoms. On the other hand, pegylated interferon (without ribavirin) is also used to treat hepatitis B, and 11.2% of the dually infected patients experienced HBsAg clearance after hepatitis C therapy.

http://www.hcvadvocate.org/news/newsRev/2009/HJR-6.3.html#3

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