Clinical and histological impact of previous hepatitis B virus infection in patients with chronic hepatitis C

• Published in: Liver international Vol. 29; no. 1; pp. 133 - 140
• Main Authors: Carvalho-Filho, Roberto J., De Lucca Schiavon, Leonardo, Narciso-Schiavon, Janaína L., Sampaio, Juliana P., Lanzoni, Valéria P., Gomes Ferraz, Maria L., Benedito Silva, Antonio E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2009
• Subjects: Adolescent; Adult; Age; Chronic infection; co-infection; Core protein; Cross-Sectional Studies; Female; Fibrosis; Hepatitis B; Hepatitis B - complications; Hepatitis B virus; Hepatitis C; Hepatitis C virus; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - pathology; Humans; Immunodeficiency; Liver; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; liver fibrosis; Male; Multivariate analysis; occult hepatitis B; previous hepatitis B; Replication; Statistics, Nonparametric
• ISSN: 1478-3223; 1478-3231; 1399-1698
• DOI: 10.1111/j.1478-3231.2008.01786.x

Background: Recent reports suggest that hepatitis C virus (HCV) carriers with serological markers of prior hepatitis B virus (HBV) infection have more advanced liver fibrosis, irrespective of HBV‐DNA detection. Aims: We sought to assess the prevalence and impact of previous HBV infection in patients with HCV chronic infection. Methods: This cross‐sectional study included hepatitis B surface antigen‐ and human immunodeficiency virus‐negative subjects with positive HCV‐RNA. All patients had prior parenteral exposure as the probable source of HCV infection. Serum samples were tested for HBV‐DNA using a commercial assay. The METAVIR system was used for histological analysis. Results: One‐hundred and eleven patients were evaluated. Thirty‐one out of 111 patients (28%) tested positive for antihepatitis B core antigen (anti‐HBc). HBV‐DNA was not detected in any sample. Anti‐HBc‐positive patients showed higher histological grading, staging and a higher fibrosis progression rate. By multivariate analysis, anti‐HBc‐positivity was predictive of moderate to severe activity [odds ratio (OR)=3.532; P=0.032] and significant hepatic fibrosis (OR=3.364; P=0.017). After approximately 20 years of infection, advanced liver fibrosis (F3/F4) can be expected in 13% of anti‐HBc‐negative subjects who acquired HCV before the age of 30 and in 57% of those anti‐HBc‐positive patients who were infected by HCV after 30 years of age (P<0.001). Conclusion: Previous HBV infection is common among HCV carriers and may exert a negative impact on the natural history of HCV infection, independently of the presence of significant HBV replication.