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Perspectives on dual hepatitis B and C infection in Taiwan
Chun-Jen Liu1, Pei-Jer Chen1, Ding-Shinn Chen1
1Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Insights
Dual hepatitis C virus (HCV) and hepatitis B virus (HBV) infection increases liver disease risk. Peginterferon-based therapy shows efficacy, with some patients clearing HBV surface antigen.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
Background:
- Dual hepatitis C virus (HCV) and hepatitis B virus (HBV) infections are prevalent in endemic areas and among populations with parenteral viral transmission risks.
- Clinical studies indicate a heightened risk of liver disease progression in dually infected patients compared to those with single HBV or HCV infections.
Purpose of the Study:
- To review the efficacy and safety of current and emerging therapies for dual HCV/HBV infection.
- To discuss optimal treatment strategies for specific clinical scenarios in dually infected patients.
Main Methods:
- Review of recent clinical trials and observational studies on dual HCV/HBV infection management.
- Analysis of treatment outcomes with peginterferon-based therapies and direct-acting antivirals (DAAs).
Main Results:
- Combination therapy with peginterferon alfa-2a/2b and ribavirin is effective and safe for dually infected patients with positive HCV RNA.
- Approximately 30% of dually infected patients achieved hepatitis B surface antigen clearance within 5 years of peginterferon therapy.
- Direct-acting antivirals (DAAs) are effective against HCV but lack activity against HBV, necessitating concurrent HBV treatment.
Conclusions:
- Peginterferon-based therapy offers a viable treatment option for dual HCV/HBV infection, with potential for HBV clearance.
- Further research is needed to establish optimal treatment strategies for complex cases, including active hepatitis B or decompensated cirrhosis.
- Future treatment paradigms may involve DAAs for HCV combined with nucleos(t)ide analogs for concurrent HBV management.
Abstract:
Dual hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is not rare in HBV or HCV endemic areas, and can be found in populations at risk of parenteral viral transmission. Clinical observatory studies suggest a higher risk of liver disease progression in patients with dual HCV/HBV infection than in HBV or HCV monoinfected patients. Recent trials confirmed that combination therapy of peginterferon alfa-2a or alfa-2b and ribavirin was effective and safe in dually infected patients with positive HCV RNA. Moreover, about 30% of the dually infected patients cleared hepatitis B surface antigen within 5 years after the start of peginterferon-based therapy. The optimal treatment strategies for dually infected patients with active hepatitis B, with decompensated cirrhosis, or in other clinical situations should be explored in further studies. Finally, the advent of new direct-acting antiviral-based anti-HCV therapy may lead to the development of strategies for the treatment of dually infected patients with active hepatitis C, particularly for those not tolerating or not eligible for peginterferon-based therapy. Notably, direct-acting antivirals would not have any activity against HBV infection; simultaneous or on-demand nucleos(t)ide analogs would be needed if clinically indicated.
