Pegylated Interferon plus Ribavirin in Patients with HBV-HCV Dual Infection

Dual infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is common, especially in areas with a high endemic level of both infections. It is estimated that about 10% of patients with chronic hepatitis B also have chronic hepatitis C, while 2%-10% of those with HCV also have HBV.

Patients with dual HBV-HCV infection typically have more severe liver disease and an increased risk of hepatocellular carcinoma compared to individuals with either virus alone.

As reported at the 42nd Annual Meeting of the European Association for the Study of the Liver this month in Barcelona, Spain, researchers from Taiwan -- where HBV infection is endemic and most people acquire the virus perinatally -- conducted a multicenter trial of treatment in dually infected patients.

Eligible participants had active HCV infection (HCV RNA of at least 100,000 copies/mL; serum ALT of at least 1.5 x ULN). Half were also HBsAg positive (indicating HBV coinfection), while half were HBsAg negative.

Subjects with genotype 1 HCV were treated with pegylated interferon alfa-2a (Pegasys) plus 1000-1200 mg/day ribavirin for 48 weeks. Those with non-1 genotypes received Pegasys plus 800 mg/day ribavirin for 24 weeks.

By the end of February 2007, 8.1% of patients withdrew prematurely from the study. A total of 234 patients completed treatment and follow-up, with the remainder still undergoing therapy.

Results

• Patients coinfected with genotype 1 HCV and HBV achieved a sustained virological response (SVR) rate of 63%, somewhat lower than the rate in HCV monoinfected subjects (76%).
  
  
• Among patients with genotype non-1 HCV and HBV, the SVR rate was 83% -- similar to that of HCV monoinfected patients (88%).
  
  
• HBV virological response was observed in 51% of the dually infected patients with HBeAg negative hepatitis B.
  
  
• HBV viral load rebound occurred in 32% of dually infected patients whose pre-treatment HBV DNA was undetectable.
  
  
• None of the dually infected patients lost HBsAg by the end of follow-up.
  
  
• HCV monoinfected patients were slightly more likely to achieve ALT normalization compared with dually infected patients (69% vs 59%).
  
  
• A total of 26 participants withdrew from the study prematurely.

Conclusion

“Combination therapy using Pegasys with ribavirin appears to be safe and effective for patients dually infected with HCV and HBV,” the researchers concluded.

National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan-R.O.C.; Kaohsiung Medical University Hospital, Kaohsiung, Taiwan-R.O.C.; Chang Gung Memorial Hospital Kaohsiung, Kaohsiung, Taiwan-R.O.C.; Changua Christian Hospital, Changhua, Taiwan-R.O.C.; Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan-R.O.C.; Chi-Mei Medical Center, Tainan, Taiwan-R.O.C.; Tri-Service General Hospital, Taipei, Taiwan-R.O.C.; Chang Gung Memorial Hospital, ChiaYi, Taiwan-R.O.C.; Cathay General Hospital, Taipei, Taiwan-R.O.C.

04/27/07

References
C-J. Liu, P-J Chen, J-H Kao, and others. An open-label, comparative, multicenter study of peginterferon alfa-2a plus ribavirin for chronic hepatitis C/hepatitis B co-infection versus chronic hepatitis C monoinfection: an interim report. 42nd Annual Meeting of the European Association for the Study of the Liver. Barcelona, Spain. April 11-15, 2007.

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