Clinical and histological impact of previous hepatitis B virus infection in patients with chronic hepatitis C.
BACKGROUND
Recent reports suggest that hepatitis C virus (HCV) carriers with serological markers of prior hepatitis B virus (HBV) infection have more advanced liver fibrosis, irrespective of HBV-DNA detection.


OBJECTIVE
We sought to assess the prevalence and impact of previous HBV infection in patients with HCV chronic infection.


METHODS
This cross-sectional study included hepatitis B surface antigen- and human immunodeficiency virus-negative subjects with positive HCV-RNA. All patients had prior parenteral exposure as the probable source of HCV infection. Serum samples were tested for HBV-DNA using a commercial assay. The METAVIR system was used for histological analysis.


RESULTS
One-hundred and eleven patients were evaluated. Thirty-one out of 111 patients (28%) tested positive for antihepatitis B core antigen (anti-HBc). HBV-DNA was not detected in any sample. Anti-HBc-positive patients showed higher histological grading, staging and a higher fibrosis progression rate. By multivariate analysis, anti-HBc-positivity was predictive of moderate to severe activity [odds ratio (OR)=3.532; P=0.032] and significant hepatic fibrosis (OR=3.364; P=0.017). After approximately 20 years of infection, advanced liver fibrosis (F3/F4) can be expected in 13% of anti-HBc-negative subjects who acquired HCV before the age of 30 and in 57% of those anti-HBc-positive patients who were infected by HCV after 30 years of age (P<0.001).


CONCLUSIONS
Previous HBV infection is common among HCV carriers and may exert a negative impact on the natural history of HCV infection, independently of the presence of significant HBV replication.
Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil. roberto.jcf@uol.com.br
Roberto J
RJ
Carvalho-Filho
Leonardo
L
de Lucca Schiavon
Janaína L
JL
Narciso-Schiavon
Juliana P
JP
Sampaio
Valéria P
VP
Lanzoni
Maria L
ML
Gomes Ferraz
Antonio E
AE
Benedito Silva
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology*; D008297:Male; D018709:Statistics, Nonparametric