HEPATITIS B VIRUS (HBV) AND HEPATITIS C VIRUS (HCV) DUAL INFECTION: INTERACTIONS AND TREATMENT OUTCOME 1Nikolaos 11st
Papadopoulos, 2Dimitris Konstantinou, 2George Kontos, 2Maria Papavdi, 1Anna Pavlidou, 2Spilios Manolakopoulos, 2John Koskinas, 3George V. Papatheodoridis, 2Melanie Deutsch
Department of Internal Medicine, 417 Army Share Fund Hospital of Athens, Athens, Greece Department of Internal Medicine, Athens University Medical School, Hippokration Hospital of Athens, Athens, Greece Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, Athens, Greece
22nd
3Academic
BACKGROUND HBV and HCV coinfection represent a special clinical entity usually with HCV predominance. While interferon based regimens were until recently the preferred therapy, direct acting antivirals (DAA’s) may be more effective. HCV clearance may lead to HBV reactivation.
AIM
Clinical features, n/N (%) CHB/CHC, 21/25 (84)
HCV superinfection, 2/25 (8)
To evaluate HBV/HCV co-infected patients admitted to our liver centers, emphasizing the initial clinical profile, treatment and outcomes.
HBV superinfection, 2/25 (8) Overall, n/N (%)
METHODS We retrospectively enrolled 40 HBV/HCV co-infected patients [M/F: 26/14, mean age: 47±15 years, cirrhosis: 17%, parenteral drug users: 58.5%, HBeAg positive: 25%, Greeks: 85.5%] admitted between 1990 and 2016.
CHB/CHC
CHB/CHC, 5/15 (33.5) 25/40 (62.5)
14/25 (56)
HCV superinfection, 3/15 (20)
Acute HCV superinfection
5/40 (12.5)
HBV superinfection, 8/15 (53)
Acute HBV superinfection
10/40 (25)
Treatment, n/N (%)
25/40 (62.5)
Follow-up [median (range)], months
24 (1-300)
IFN based, 1 (50) NUC, 1 (50) IFN based, 16/25 (64) NUC based, 4/25 (16) DAA’s, 5/25 (20)
HBsAg clearance, n (%) 4 (31) 0 (0) 0 2 (100) 0 (0) 1 (100) 6/16 (37.5) 1/4 (25) 0/5 (0)*
HCV eradication, n (%) 4 (31) 0 (0) 3 (60) 2 (100) 0 (0) 1 (100) 6/16 (37.5) 1/4 (25) 3/5 (60)**
Table 3. Outcomes according initial clinical features among non-treated patients (N=15)
Clinical features, n/N (%)
Inactive HBV carrier
o
Treatment regimen, n (%) IFN based, 13 (62) NUC, 3 (14) DAA’s, 5 (24) IFN based, 2 (100)
*HBV reactivation in one patient (one month after SVR with SOF/LDV/RBV) successfully treated with TDF) **SVR is pending in 2 patients
Table 1. Clinical characteristics Clinical features, n/N (%)
CONCLUSION
RESULTS Table 2. Outcomes according initial clinical features among treated patients (N=25)
Overall, n/N (%)
Reason of no treatment, n (%) Contraindication, 2 (40) Patient’s choice, 1 (20) Lost, 1 (20) Contraindication, 3 (100)
HBsAg clearance, n (%) 0 (0) 0 (0) unknown 0 (0)
HCV eradication, n (%) 0 (0) 0 (0) unknown 1 (33.5)
Contraindication, 7 (87.5) Lost, 1 (12.5) Contraindication, 12/15 (80) Patient’s choice, 1/15 (6.5) Lost, 2/15 (13.5)
6 (75) unknown 6/12 (50)
5 (62.5) unknown 6/12 (50)
0/1 (0)
0/1 (0)
unknown
unknown
Although HCV dominance was documented, a significant proportion of our patients presented with active HBV replication indicating a significant role for HBV. Treatment with DAA’s seems to be efficacious in HCV eradication. However, clinicians should be very carefully for HBV reactivation after DAA’s therapy. HBV superinfection may lead to both HBsAg and HCV clearance.
REFERENCES Konstantinou D and Deutsch M. The spectrum of HBV/HCV coinfection: epidemiology, clinical characteristics, viral interactions and management. Ann Gastroenterol 2015;28:221– 28. Liaw YF. Hepatitis C virus superinfection in patients with chronic hepatitis B virus infection. J Gastroenterol 2002;37(Suppl 13):6568. Liaw YF, Yeh CT, Tsai SL. Impact of acute hepatitis B virus superinfection on chronic hepatitis C virus infection. Am J Gastroenterol 2000;95:2978-80. Yan BM, Lee SS. Acute coinfection with hepatitis B and hepatitis C viruses. Can J Gastroenterol 2005;19:729-30.
DISCLOSURES None
Contact information Nikolaos Papadopoulos M.D, PhD e-mail:
[email protected]
