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.
Carvalho-Filho
Roberto J
RJ
Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil. roberto.jcf@uol.com.br
de Lucca Schiavon
Leonardo
L
Narciso-Schiavon
Janaína L
JL
Sampaio
Juliana P
JP
Lanzoni
Valéria P
VP
Gomes Ferraz
Maria L
ML
Benedito Silva
Antonio E
AE
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