title: Viral interaction and clinical implications of coinfection of hepatitis C virus with other hepatitis viruses.
abstract: Coinfection with other hepatitis viruses modifies the viral profile in serum and leads to more liver damage and more rapid progression during the course of hepatitis C virus infection. The viral interference is not only carried out by virus-virus or by virus-cell interactions but also by an enhanced immune response. A superinfecting viral infection does not crossactivate protective immune responses to the pre-existing virus albeit the latter can become undetectable. The induced cytokine stimulation might enhance the hepatic inflammation. Moreover, hepatitis B virus coinfection increases the risk of development of hepatocellular carcinoma in hepatitis C virus patients through common necro-inflammatory pathways or by direct oncogenic activity of hepatitis B virus. Viral interaction also complicates the management of the coinfection because hepatitis C virus impairs the humoral response to hepatitis A virus and hepatitis B virus vaccines, and because pharmacological suppression of hepatitis C virus endangers dually infected patients with reactivation of coinfected hepatitis B virus. Optimized strategies and follow-up are thus necessary in the treatment of infection with multiple viruses. It seems thus necessary to look for markers of hepatitis B virus and/or hepatitis D virus infection in chronic hepatitis patients positive for hepatitis C virus antibodies but negative for hepatitis C virus RNA, and equally well to search for hepatitis C virus RNA in HBsAg-negative/anti-HBc-positive patients with a low level of serum hepatitis B virus DNA.
authors.affiliation: Department of Hepatology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Lan
authors.initials: L
authors.lastname: Lin
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.forename: Jos F
authors.initials: JF
authors.lastname: van Pelt
authors.forename: Marc
authors.initials: M
authors.lastname: van Ranst
authors.forename: Johan
authors.initials: J
authors.lastname: Fevery
mesh_terms: D000818:Animals; D016207:Cytokines / Q000096:biosynthesis; D005814:Genes, Viral; D016174:Hepacivirus / Q000235:genetics / Q000502:physiology; D006509:Hepatitis B / Q000150:complications / Q000276:immunology / Q000821:virology; D006515:Hepatitis B virus / Q000235:genetics / Q000502:physiology; D006526:Hepatitis C / Q000150:complications* / Q000276:immunology / Q000821:virology; D006525:Hepatitis, Viral, Human / Q000150:complications / Q000276:immunology / Q000821:virology; D006801:Humans; D009154:Mutation
chemical_list: D016207:Cytokines