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Response of patients with dual hepatitis B virus and C virus infection to interferon therapy
1Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.
Insights
Interferon therapy shows limited effectiveness for patients with co-infection of hepatitis B virus (HBV) and hepatitis C virus (HCV). This treatment may pose risks, including severe hepatitis, in dual HBV/HCV infections.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Dual infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) present unique challenges in treatment.
- Limited data exists on the efficacy of interferon (IFN) therapy in patients coinfected with HBV and HCV.
Purpose of the Study:
- To evaluate the response to IFN therapy in patients with chronic HBV infection who are also positive for HCV markers.
- To compare IFN treatment outcomes in HBV/HCV coinfected patients versus HBV-monoinfected patients.
Main Methods:
- Retrospective analysis of patients from two randomized controlled trials for chronic HBV infection, assessing HCV markers.
- Comparison of HBV treatment responses (DNA, HBeAg clearance) between HCV-positive and HCV-negative patient groups.
- An open trial in four patients who lost HBsAg but had persistent HCV viremia.
Main Results:
- Only 6.7% of HCV-positive patients achieved HBV DNA and HBeAg seroclearance compared to 28% of HCV-negative patients (p=0.058).
- One patient developed icteric hepatitis upon HCV RNA emergence and HBV DNA clearance.
- Three of four patients with prior HBsAg loss and ongoing HCV hepatitis responded well to IFN therapy.
Conclusions:
- IFN therapy has limited efficacy and potential risks, such as severe hepatitis, in patients coinfected with HBV and HCV.
- IFN treatment may facilitate the emergence of HCV upon HBV clearance in coinfected individuals.
- Patients with HCV hepatitis after resolving chronic HBV infection may respond favorably to IFN therapy.
Abstract:
Patients with dual infection with hepatitis B virus (HBV) and delta virus (HDV) responded poorly to interferon (IFN) therapy. Little is known about the effect of IFN therapy in patients with HBV and hepatitis C virus (HCV) dual infection. The patients in two randomized controlled trials with chronic HBV infection were retrospectively assayed for HCV markers. The HBV responses to IFN therapy in patients with and without HCV markers were compared. An open trial was conducted in 4 patients who had lost their serum HBV surface antigen (HBsAg) but had continuing HCV viremia and hepatitis. Of the 15 patients seropositive for HCV marker(s), only 1 (6.7%) responded with seroclearance of HBV DNA and HBV e antigen, as compared with 46 (28%) of 164 HCV-negative patients (p = 0.058). Icteric hepatitis developed in 1 patient on emergence of serum HCV RNA in association with seroclearance of HBV DNA. In contrast, good response was demonstrated in 3 of the 4 patients who had lost serum HBsAg before therapy. The results suggest that IFN therapy is not only of limited value in patients with dual infection with HBV and HCV but also has a potential risk of severe hepatitis if the clearance of one virus removes its suppressive effect on and facilitates the emergence of the other. However, patients with continuing HCV hepatitis after termination of the chronic HBsAg carrier state responded well to IFN therapy.