Coinfection

EASL 2015: Hepatitis B and C Coinfection Linked to Worse Fibrosis than Hepatitis B Alone

People coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV) may experience more rapid and severe liver disease progression than those with hepatitis B alone, though HBV/HCV coinfection did not appear to worsen hepatitis C progression, according to a French study presented at the European Association for the Study of the Liver (EASL) 50th International Liver Congress last month in Vienna.

Due to overlapping transmission routes, many people are coinfected with both HBV and HCV. Previous research has shown that HBV and HCV appear to compete with each other in the body, with one typically becoming dominant. Studies indicate that coinfection with both viruses may lead to more severe liver disease, but research has been limited for non-Asian patients (Asia and Africa have the highest prevalence of hepatitis B worldwide).

Stanislas Pol from Université René Descartes in Paris and colleagues analyzed characteristics and outcomes among HBV/HCV coinfected patients in the ANRS CO22 HEPATHER cohort, comparing them to participants with either hepatitis B or C monoinfection.

HEPATHER is a large cohort of people with hepatitis B and/or C followed at more than 30 centers in France with centralized collection of biological specimens. It aims to enroll 10,000 hepatitis B and 15,000 hepatitis C patients.

This analysis looked at 14,698 participants enrolled as of November 2014. Within this group, 1099 had serological evidence of having been infected with both HBV and HCV, while 9098 had HCV alone and 4501 had HBV alone. Of these, 92 people with markers of active HBV and HCV coinfection were matched by age, sex, and duration of infection with 4 patients with HBV alone and 4 with HCV alone.

Results

• People with HCV alone were more likely to have metropolitan origin (63%) compared to HBV/HCV coinfected patients (48%) or those with HBV alone (29%).
• Coinfected patients were less likely to have received hepatitis C treatment than those with HCV alone (51% vs 67%), and less likely to be on ongoing hepatitis B treatment than those with HBV alone (29% vs 38%).
• Rates of hepatitis delta (HDV) infection were similar in hepatitis B patients with and without HCV, and HCV genotype distribution was the same for hepatitis C patients with and without HBV.
• Coinfected people were less likely to be overweight or obese than people with HBV alone, but more likely to have high blood pressure; there were no notable differences in these factors between coinfected patients and those with HCV alone.
• Coinfected patients and those with HCV alone had similar rates of advanced fibrosis or cirrhosis (Metavir stage F3-F4), but both were significantly higher than the rate for patients with HBV alone (42% and 40% vs 15%, respectively).
• Coinfected patients were significantly more likely to have low-level HBV DNA (<50 IU/mL) than those with HBV alone (87% vs 62%), supporting the idea that HCV suppresses HBV.
• However, coinfected patients and those with HCV alone were about equally likely to have high HCV RNA levels (>6.1 log) at enrollment (43% vs 49%).

"HBV coinfection was not associated with the severity of HCV-associated chronic hepatitis," the researchers summarized. "In contrast, HCV coinfection harmfully impacted on fibrosis [in people with HBV]." Interestingly, they added, "HCV coinfection may reduce HBV replication in B/C coinfected patients."

Thus, they concluded, "HCV treatment initiation must be prioritized in patients with an HBV/HCV coinfection, regardless of the severity of liver disease."

5/19/15

Reference

S Pol, S Lucier, H Fontaine, et al. Negative impact of HBV/HCV coinfection on HBV or HCV monoinfection: data from the French cohort -- ANRS CO22 HEPATHER. 2015 International Liver Congress: 50th Annual Meeting of the European Association for the Study of the Liver (EASL). Vienna, April 22-26, 2015. Abstract P0468.