Coinfection May Experience HBV Relapse after Sustained HCV Suppression

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Patients with HBV/HCV Coinfection May Experience HBV Relapse after Sustained HCV Suppression

SUMMARY: Individuals coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV) experienced rates of sustained virological response to pegylated interferon plus ribavirin that were similar to those of HCV monoinfected patients, researchers reported in the November 2009 issue of Liver International. However, while HBV levels are typically suppressed in HBV/HCV coinfected people, HBV levels may rise after HCV is cured.

By Liz HighleymanChinese researchers conducted a study to assess the virological features of 50 patients coinfected with HBV and HCV, as well as the efficacy of combination therapy with pegylated interferon alpha-2a (Pegasys) plus ribavirin in this group.Results

92% of the coinfected patients had HCV-dominant virus strains, while 8% had mixed HCV- and HBV-dominant strains.

Coinfected patients had an average HBV DNA level of 4.6 log10 copies/mL, significantly lower than the 5.9 log10 copies/mL seen in HBV monoinfected individuals.

Coinfected patients were also significantly less likely than HBV monoinfected patients to be hepatitis B "e" antigen (HBeAg) positive (12.0% vs 45.3%).

Among participants with HCV genotype 1, HBV/HCV coinfected patients had significantly higher early response rates compared with HCV monoinfected individuals:

Partial early virological response (pEVR): 50.0% vs 16.0%, respectively;

End-of-treatment virological response (ETVR): 90.0% vs 56.0%, respectively).

However, the relapse rate among genotype 1 coinfected patients was also higher (55.6% vs 21.4%).

HBV/HCV coinfected and HCV monoinfected patients, therefore, had similar sustained virological response (SVR) rates (40.0% vs 44.0%, respectively).

There were no significant differences in on-treatment virological response, ETVR, relapse, or SVR rates between coinfected and monoinfected patients with HCV genotype 2.

Coinfected patients had a significantly greater incidence of side effects compared with HCV monoinfected individuals (30% vs 13%, respectively).

Coinfected participants who achieved sustained response were nearly 4 times more likely to experience HBV reactivation (i.e., increased HBV DNA) compared with those who did not attain SVR (33.3% vs 8.7%.

In coinfected patients, the study authors concluded, "The replication of HBV was suppressed, and HCV was the dominant virus strain."

"Compared with HCV monoinfected patients, pEVR, ETVR, and relapse rates of patients with genotype 1 in the coinfection group were high, while they shared similar SVR rates," they continued. "HBV and HCV coinfection had no impact on the rate of virological response for genotype 2."

12/15/09

Department of Infectious Diseases, Second Affiliated Hospital, Harbin Medical University, Harbin, China.

ReferenceJ Yu, LJ Sun, YH Zhao, and others. Analysis of the efficacy of treatment with peginterferon alpha-2a and ribavirin in patients coinfected with hepatitis B virus and hepatitis C virus. Liver International 29(10): 1485-1493 (Abstract). November 2009.

http://www.hivandhepatitis.com/hep_c/news/2009/121509_b.html