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Effect of concurrent acute infection with hepatitis C virus on acute hepatitis B virus infection
L T Mimms1, J W Mosley, F B Hollinger
1Abbott Laboratories, Abbott Park, Illinois.
Objective:
To investigate the possible interference with acute hepatitis B virus infection by co-infection with hepatitis C virus.
Design:
Analysis of stored sera collected for transfusion transmitted viruses study in 1970s.
Setting:
Four major medical centres in the United States.
Patients:
12 recipients of blood infected with hepatitis B virus.
Main Outcome Measures:
In 1970s, presence of antibodies in hepatitis B virus and raised serum alanine aminotransferase concentration; detection of antibodies to hepatitis C virus with new enzyme linked immunoassays.
Results:
Five of the 12 patients were coinfected with hepatitis C virus. Hepatitis B surface antigen was first detected at day 59 in patients infected with hepatitis B virus alone and at day 97 in those coinfected with hepatitis C virus (p = 0.01); median durations of antigenaemia were 83 and 21 days respectively (p = 0.05), and the antigen concentration was lower in the coinfected patients. Alanine aminotransferase patterns were uniphasic when hepatitis B virus infection occurred alone (range 479-2465 IU/l) and biphasic in patients with combined acute infection (no value > 380 IU/l; p = 0.0025). Four coinfected recipients developed chronic hepatitis C virus infection. The fifth patient was followed for only four months.
Conclusions:
Acute coinfection with hepatitis C virus and hepatitis B virus inhibits hepatitis B virus infection in humans, and onset of hepatitis B may reduce the severity of hepatitis C virus infection but not frequency of chronicity. Alanine aminotransferase concentration showed a biphasic pattern in dual infection.