Profound suppression of chronic hepatitis C following superinfection with hepatitis B virus.
BACKGROUND
Hepatitis B virus (HBV) and hepatitis C virus (HCV) share similar transmission routes; thus, coinfection is frequent. The consequences of acute HBV infection in patients with chronic hepatitis C are unknown.


METHODS
We describe a 47-year-old male with chronic hepatitis C who acquired HBV and then spontaneously and apparently completely cleared HCV but developed chronic hepatitis B. Five serum samples collected over 14 months and lymphoid cells obtained after acquiring HBV were tested for HCV and HBV by both standard assays and ultra-sensitive polymerase chain reaction/nucleic acid hybridization (PCR/NAH) (sensitivity approximately 2 IU/ml).


RESULTS
After superinfection with HBV, HBV surface antigen-positive chronic hepatitis developed with readily detectable HBV DNA. All sera collected after acquisition of HBV, which tested negative for HCV RNA by standard laboratory assay, were positive for HCV genomes when analysed by PCR/NAH. Peripheral lymphoid cells carried HBV DNA and covalently closed circular DNA, but were negative for HCV.


CONCLUSIONS
This is the first reported case of profound suppression of chronic hepatitis C after superinfection with HBV and establishment of chronic hepatitis B. It is hypothesized that HBV infection precipitated generalized and/or virus-specific cellular immune responses that profoundly suppressed HCV replication and yet failed to inhibit progression to chronic hepatitis B.
Coffin
Carla S
CS
Liver Unit, Division of Gastroenterology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
Mulrooney-Cousins
Patricia M
PM
Lee
Samuel S
SS
Michalak
Tomasz I
TI
Swain
Mark G
MG
D004279:DNA, Viral / Q000097:blood*; D016679:Genome, Viral; D016174:Hepacivirus / Q000502:physiology; D006509:Hepatitis B / Q000503:physiopathology*; D006515:Hepatitis B virus / Q000502:physiology; D019698:Hepatitis C, Chronic / Q000503:physiopathology*; D006801:Humans; D008214:Lymphocytes / Q000821:virology; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood*; D015163:Superinfection / Q000503:physiopathology*; D014779:Virus Replication / Q000502:physiology
D004279:DNA, Viral; D012367:RNA, Viral