title: Hepatitis C virus superinfection in hepatitis B virus chronic carriers: a reciprocal viral interaction and a variable clinical course.
abstract: BACKGROUND
  The virological and clinical impact of hepatitis C virus (HCV) superinfection in chronic hepatitis B virus (HBV) carriers has been poorly characterized.
  
  
  OBJECTIVE
  To evaluate the viral interaction, clinical presentation and course of the disease in four HBsAg/HBV-DNA positive chronic hepatitis patients who developed acute HCV infection.
  
  
  METHODS
  To evaluate clinical, virological and laboratory data for at least 6 months from the onset of acute HCV infection in patients with chronic HBV infection.
  
  
  RESULTS
  Three patients with acute HCV infection had a normal clinical course, but the remaining patient had severe disease with ascites and a marked decrease in prothrombin activity. In all cases, plasma HBV-DNA, which had been detectable prior to the HCV infection, was no longer detectable when the acute HCV infection occurred. The inhibition exerted by HCV on HBV-DNA persisted throughout the follow-up period in three patients, but was temporary in the one patient who experienced an acute exacerbation of chronic HBV infection. HCV-RNA became persistently undetectable in two patients and reduced to low levels in the other two.
  
  
  CONCLUSIONS
  Acute HCV infection in the four HBV chronic carriers was characterized by a reciprocal inhibition of HBV-HCV genomes and, in one case, by a severe course of disease.
authors.affiliation: Division of Infectious Diseases, San Sebastiano Hospital, Caserta, Italy. evangelista.sagnelli@unina2.it
authors.forename: Evangelista
authors.initials: E
authors.lastname: Sagnelli
authors.forename: Nicola
authors.initials: N
authors.lastname: Coppola
authors.forename: Cecilia
authors.initials: C
authors.lastname: Marrocco
authors.forename: Mirella
authors.initials: M
authors.lastname: Onofrio
authors.forename: Caterina
authors.initials: C
authors.lastname: Sagnelli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Coviello
authors.forename: Carlo
authors.initials: C
authors.lastname: Scolastico
authors.forename: Pietro
authors.initials: P
authors.lastname: Filippini
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001201:Ascites; D002353:Carrier State / Q000821:virology*; D004279:DNA, Viral / Q000097:blood; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D006526:Hepatitis C / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D008297:Male; D011517:Prothrombin Time; D012367:RNA, Viral / Q000097:blood; D015163:Superinfection
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral; D000410:Alanine Transaminase