By Liz Highleyman

Due to overlapping transmission routes, many people are infected with both hepatitis B virus (HBV) and hepatitis C virus (HCV).

While HBV-HCV coinfection has not been extensively studies, infection with both viruses has been associated with more severe liver disease and more rapid progression to cirrhosis and hepatocellular carcinoma. However, data also suggest that the 2 viruses inhibit one another, such that suppression of one may lead to increased replication of the other.

At the 43rd annual meeting of the European Association for the Study of the Liver (EASL 2008) last month in Milan, German researchers presented results from the Hep-Net HBV-HCV coinfection trial, a prospective multicenter study investigating the efficacy of pegylated interferon and ribavirin in patients with both viruses.

The trial included 19 patients with chronic HBV-HCV coinfection. All were positive for hepatitis B surface antigen (HBsAg), but 13 (68%) had undetectable HBV DNA at baseline. All had detectable HCV RNA; 10 were infected with HCV genotype 1, the rest with genotype 2 or 3.

Study participants were treated with standard hepatitis C therapy consisting of weight-adjusted pegylated interferon alfa-2b (PegIntron) plus ribavirin for 48 weeks.

Results

• 12 of 19 patients (63%) experienced end-of-treatment and sustained biochemical response (ALT normalization).

• 14 of 19 (74%) achieved sustained virological response (SVR), or continued undetectable HCV RNA 24 weeks after completion of therapy.

• 14 of 15 patients (93%) who were adherent to therapy achieved end-of-treatment and sustained HCV virological response (88% for genotype 1; 100% for genotypes 2/3).

• At week 24 of follow-up, 2 of the 5 patients who initially had detectable HBV viremia became HBV DNA negative.

• Conversely, 4 patients who were HBV DNA negative at baseline developed detectable HBV viremia after HCV clearance.

• None of these 4 patients experienced hepatitis flares associated with recurrent HBV viremia.

• Treatment was well tolerated and adverse events were comparable to those seen in trials of patients with HBV or HCV monoinfection.

Conclusion

Based on these findings, the investigators concluded, "Combination therapy with [pegylated interferon alfa-2b and ribavirin] is at least as effective in inducing a sustained HCV RNA response in patients with HBV-HCV coinfection as compared with HCV monoinfection."

However, they added, "HBV replication may increase after clearance of HCV, and thus close monitoring for both viruses is recommended even in patients with initially undetectable HBV DNA."

Hannover Medical School, Hannover, Germany; University of Mainz, Mainz, Germany; University of Berlin, Campus Virchow-Klinikum, Berlin, Germany; University of Frankfurt, Frankfurt, Germany; II.Medizinische Klinik, Diakoniekrankenhaus Rotenburg/Wuemme, Rotenburg, Germany; University of Bonn, Bonn, Germany; Gastroenterologische Praxis, Magdeburg, Germany; Gastroenterologische Praxis, Freudenstadt, Germany; Internistische Praxis, Boeblingen, Germany; Medizinische Klinik III, University of Aachen, Aachen, Germany.

5/09/08

Reference
A Potthoff, H Wedemeyer, WO Boecher, and others. The Hep-Net B/C co-infection trial: a prospective multicenter study to investigate the efficacy of pegylated interferon-a2b and ribavirin in patients with HBV/HCV co-infection. 43rd annual meeting of the European Association for the Study of the Liver (EASL 2008). Milan, Italy. April 23-27, 2008.