title: Displacement of hepatitis B virus by hepatitis C virus as the cause of continuing chronic hepatitis.
abstract: OBJECTIVE
  It has been shown that hepatitis C virus (HCV) superinfection may suppress hepatitis B virus (HBV) leading to hepatitis B surface antigen (HBsAg) clearance and that hepatitis may persist after HBsAg clearance in a few patients. The role of HCV in continuing hepatitis after termination of chronic HBsAg antigenemia remains to be explored in a series of patients.
  
  
  METHODS
  HCV markers were studied using second generation enzyme immunoassay and polymerase chain reaction with reverse transcription and were compared between 41 patients with persistent alanine aminotransferase (ALT) elevation (hepatitis group) and 82 age/sex-matched patients with normal ALT (control group) after HBsAg clearance.
  
  
  RESULTS
  Twenty-six (63%) of the 41 hepatitis group patients were seropositive for antibodies to HCV (anti-HCV) compared with only 4 (5%) of 82 controls (P < 0.0001). Six patients of the hepatitis group and 1 control had an episode of acute hepatitis C with seroconversion of anti-HCV 1-68 months before HBsAg clearance. Of those seropositive for anti-HCV, serum HBV DNA was not detectable, and serum HCV RNA was detected in 23 (88.5%) of the 26 hepatitis patients but none of the 4 controls (P < 0.001). Liver biopsy in 6 anti-HCV positive patients with continuing hepatitis showed features compatible with chronic hepatitis C. HCV RNA, but not HBV DNA, was detected in liver tissues of these 6 patients.
  
  
  CONCLUSIONS
  The results suggest that HCV may usurp the role of HBV in chronic hepatitis and act as the major cause of continuing hepatitis or ALT elevation after HBV/HBsAg clearance.
authors.affiliation: Liver Unit, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Y F
authors.initials: YF
authors.lastname: Liaw
authors.forename: S L
authors.initials: SL
authors.lastname: Tsai
authors.forename: J J
authors.initials: JJ
authors.lastname: Chang
authors.forename: I S
authors.initials: IS
authors.lastname: Sheen
authors.forename: R N
authors.initials: RN
authors.lastname: Chien
authors.forename: D Y
authors.initials: DY
authors.lastname: Lin
authors.forename: C M
authors.initials: CM
authors.lastname: Chu
mesh_terms: D000328:Adult; D001483:Base Sequence; D002908:Chronic Disease; D004279:DNA, Viral / Q000378:metabolism*; D005260:Female; D016174:Hepacivirus / Q000235:genetics*; D006511:Hepatitis B Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000235:genetics*; D006525:Hepatitis, Viral, Human / Q000382:microbiology*; D006801:Humans; D008099:Liver / Q000276:immunology / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015335:Molecular Probes / Q000235:genetics; D008969:Molecular Sequence Data; D012333:RNA, Messenger / Q000378:metabolism*; D012367:RNA, Viral / Q000378:metabolism*
chemical_list: D004279:DNA, Viral; D006511:Hepatitis B Antigens; D015335:Molecular Probes; D012333:RNA, Messenger; D012367:RNA, Viral