Hepatitis C and hepatitis B coinfection
Journal
Clinical Dilemmas in Viral Liver Disease, Second Edition
ISBN
9781119533481
Date Issued
2020-01-01
Author(s)
Abstract
We may encounter patients with hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection in HBV or HCV endemic areas. Coinfection can also be found in populations at risk for parenteral transmission. Community cohort and hospital-based case-controlled studies have demonstrated a higher risk of liver disease progression in those with HCV/HBV coinfection in comparison with HBV or HCV mono-infected patients. Earlier trials supported the value of combination therapy of peginterferon alfa-2a or -2b and ribavirin for co-infected patients with positive HCV RNA. Further, HBsAg seroclearance can be achieved in about 30% of the co-infected patients within 5 years after initiating peginterferon-based therapy. However, there still exist unmet needs for those coinfected patients who are unable to tolerate or are ineligible for peginterferon-based therapy. The advent of new direct-acting antivirals (DAAs)-based anti-HCV therapy increases the rate of HCV clearance and fills the unmet gap for such patients. A recent multicenter trial in Taiwan demonstrated that the HCV sustained virologic response rate was high (100%) in coinfected patients with genotype 1 or 2 infection. Notably, DAA would not have any activity against HBV infection; thus may therefore HBV reactivation and related hepatitis activity while on HCV therapy or after cure of HCV as warned by the US FDA. Our trial data demonstrated that ~70% of the subjects experienced HBV reactivation event within 48 weeks after start of DAA therapy. Management of HBV reactivation including prevention of HBV reactivation post HCV cure is a clinical unresolved issue that needs to be addressed by further clinical trials. Overall, major advances in the treatment of HCV/HBV coinfection have been made over the past 15 years. Prevention or preemptive management of HBV reactivation would need further evaluation through rigorously done clinical trials.
Subjects
Coinfection | direct-acting antivirals | hepatitis B virus | hepatitis C virus | pegylated interferon
SDGs
Type
book part