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HBV superinfection in hepatitis C virus chronic carriers, viral interaction, and clinical course
Evangelista Sagnelli1, Nicola Coppola, Vincenzo Messina
1Division of Infectious Diseases, Azienda Ospedaliera di Caserta, Naples, Italy. evangelista.sagnelli@unina2.it
Insights
Hepatitis B virus (HBV) superinfection in chronic hepatitis C virus (HCV) carriers leads to severe acute hepatitis and suppresses HCV RNA. This HBV infection also impacts long-term outcomes for both viruses.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major global health concerns.
- Understanding the interplay between HBV and HCV infections is crucial for patient management.
- The impact of HBV superinfection on chronic HCV carriers requires further investigation.
Purpose of the Study:
- To investigate the clinical course and virological outcomes of acute HBV infection in patients with chronic HCV.
- To compare the outcomes of HBV superinfection in chronic HCV carriers with acute HBV infection in anti-HCV-negative individuals.
- To analyze the impact of concurrent HBV/HCV acute infection on viral dynamics.
Main Methods:
- Enrollment of 44 patients with acute HBV infection, categorized into groups based on HCV status.
- Utilized polymerase chain reaction (PCR) to detect HBV-DNA and HCV-RNA.
- Monitored viral markers, seroconversion, and clinical outcomes, including severe hepatitis and chronicity.
Main Results:
- HBV superinfection in chronic HCV carriers resulted in a higher incidence of severe acute hepatitis compared to controls.
- HBV infection strongly suppressed HCV-RNA levels in co-infected patients.
- Concurrent HBV/HCV infection led to the development of HCV-RNA-positive chronic hepatitis.
Conclusions:
- HBV superinfection in chronic HCV carriers is associated with a severe clinical course.
- HBV infection exerts a potent and persistent suppressive effect on HCV replication.
- The dynamics of viral clearance and chronicity differ significantly in patients with concurrent HBV/HCV infections.
Abstract:
We enrolled 44 patients with hepatitis B virus (HBV) acute infection, 21 anti-hepatitis C virus (HCV)-positive for at least 1 year (case BC group), 20 anti-HCV-negative (control B group), and 3 with HBV/HCV acute concurrent infection. For each case BC, a subject with chronic HCV infection alone was selected (control C group). At the first observation, 85.7% of patients in case BC group and 85% of those in control B group were HBV-DNA-positive (polymerase chain reaction [PCR]), with a similar trend towards a decrease and negativization in about 20 days; in the case BC group, seroconversion to antibody to hepatitis B e antigen (anti-HBe) was more rapid. HCV-RNA (PCR) was undetectable in all case BC patients but 1, who shortly became negative, whereas 85.7% of subjects in control C group were positive (P <.001). Severe acute hepatitis was more frequent in the case BC group than in the control B group (28.6% vs. 0%, P <.05). Of the 14 patients in the case BC group and of the 16 in the control B group followed up for more than 6 months, 1 in the first and 1 in the second group became hepatitis B surface angiten (HBsAg) chronic carriers. Of the 13 patients in case BC group who recovered, 1 cleared both anti-HCV and HCV-RNA, 6 became HCV-RNA-positive, and 6 remained HCV-RNA-negative. In patients with HBV/HCV acute concurrent infection, HBV-DNA became undetectable in 15 days, and HCV-RNA and anti-HCV became positive at days 30 and 45, respectively; these patients developed HCV-RNA-positive chronic hepatitis. In conclusion, HBV superinfection in chronic HCV carriers has a severe clinical course and strongly and persistently depresses HCV.