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Isolated anti-HBc in chronic hepatitis C predicts a poor response to interferon treatment
E Sagnelli1, N Coppola, C Scolastico
1Institute of Infectious Diseases, Second University of Naples, Naples, Italy. evangelista.sagnelli@unin2.it
Insights
Patients with chronic hepatitis C and isolated anti-Hepatitis B core antibody (anti-HBc) show a poor sustained response to interferon-alpha (IFN-alpha) treatment, regardless of hepatitis C virus (HCV) genotype. This finding impacts treatment strategies for coinfected patients.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Chronic hepatitis C (HCV) and hepatitis B virus (HBV) coinfection is common.
- Interferon-alpha (IFN-alpha) is a treatment for chronic hepatitis C.
- Predictors of sustained virologic response (SVR) to IFN-alpha require further investigation.
Purpose of the Study:
- To evaluate the sustained response to IFN-alpha in chronic hepatitis C patients.
- To analyze the impact of HCV genotypes and HBV serological markers on treatment outcomes.
- To identify patient subgroups with poor response to IFN-alpha therapy.
Main Methods:
- 147 anti-HCV/HCV-RNA-positive, HBsAg-negative patients received IFN-alpha (3 MU thrice weekly for 52 weeks).
- Patients were categorized by HCV genotype (1, non-1, multiple) and HBV serological status (anti-HBs/anti-HBc negative, positive, or isolated anti-HBc).
- Serum HBV-DNA was detected using polymerase chain reaction (PCR).
Main Results:
- Sustained response rates were higher for non-1 HCV genotypes (31%) versus genotype 1 (17.7%).
- Patients with isolated anti-HBc (group C) showed significantly lower sustained response rates (7.8%) compared to anti-HBs/anti-HBc negative (30.4%) or positive (28%) groups.
- HBV-DNA was detected in 29.4% of isolated anti-HBc patients, but not in others. Non-1 genotype patients in seronegative/seropositive groups had high response rates (42.8%).
Conclusions:
- Chronic hepatitis C patients with isolated anti-HBc exhibit a poor response to IFN-alpha treatment.
- HCV genotype and HBV serological status significantly influence IFN-alpha treatment efficacy.
- Isolated anti-HBc may indicate occult HBV infection and predict unfavorable outcomes in HCV patients treated with IFN-alpha.
Abstract:
The sustained response to interferon-alpha treatment was evaluated in 147 anti-HCV/HCV-RNA-positive, HBsAg-negative, chronic hepatitis patients, according to HCV genotypes and the presence or absence of anti-HBs and anti-HBc. These patients had been included in a controlled study on the safety, tolerability, and efficacy of three types of interferon-alpha given at a dose of 3 MU three times weekly for 52 weeks. One hundred and two patients had HCV genotype 1, 42 a non-1 HCV genotype and 3 multiple HCV genotypes; 46 were anti-HBs and anti-HBc negative (group A), 50 anti-HBs and anti-HBc positive (group B), and 51 anti-HBs negative and anti-HBc positive ("isolated" anti-HBc, group C). Serum HBV-DNA was detected by polymerase chain reaction in 15 of the 51 (29.4%) patients in group C and in none of those in groups A or B. The Sustained Response rate was higher in patients with a non-1 HCV genotype than those with HCV genotype 1 (31% vs. 17.7%, P > 0.1). Fewer patients in group C showed a sustained response than in group A or group B (7.8% vs. 30.4%, P = 0.009 and 7.8% vs 28%, P = 0.017, respectively). Moreover, the sustained response rate was high in patients with a non-1 genotype, both in group A (42.8%) and in group B (42.8%), intermediate in patients with HCV genotype 1 (23.3% in group A and 22.2% in group B) and low in group C, irrespective of HCV genotype (8.3% for genotype 1 and 7.1% for other genotypes). The data indicate that patients with HCV chronic hepatitis and isolated anti-HBc show a poor response to IFN-alpha, irrespective of the HCV genotype.