Triple hepatitis: frequency and treatment outcome of co/super-infection of hepatitis C and D among patients of hepatitis B.
OBJECTIVE
To determine the frequency of hepatitis C and D in patients of chronic hepatitis B and the treatment response of hepatitis B in such patients.


METHODS
Case series.


METHODS
Civil Hospital and Lyari General Hospital, Dow University of Health Sciences, from July 2003 to June 2005.


METHODS
All patients of hepatitis B presenting during the study period were screened for triple infection by carrying out anti-HBc (IgG), anti-HCV and anti-HDV. Patients who were positive to all three were included in the study. Complete Blood Count (CBC); HBsAg; HBeAg; anti-HBc IgM; anti-HDV; anti-HCV; HBV DNA PCR; HCV RNA PCR; serum albumin; SGPT; serum bilirubin and ultrasound abdomen were acquired in all patients. All patients received pegylated interferon-alpha2a 180 mcg sc weekly x 48 weeks. Patients who were also positive for HCV RNA also received ribavirin 1000-1200 mg/d po x 24 weeks for genotype 3 and 48 weeks for genotype 1. Descriptive statistics were used for describing the data.


RESULTS
Out of the 246 patients of HBV, 29 (11.8%) patients were also positive for anti-HBc IgG, anti-HDV and anti-HCV. After 48 weeks of therapy, the respective viral undetection by PCR was 4 (13.8%) in patients having only HBV DNA, 3 (10.3%) in patients with only HCV RNA and in patients who had both HBV DNA and HCV RNA positive, simultaneously HCV was cleared in 2 (6.9%) while HBV was not cleared in any case.


CONCLUSIONS
In patients coming with one hepatic infection, other infections should be sought as they share a common mode of spread and may affect the overall response to treatment.
Zuberi
Bader Faiyaz
BF
Department of Medicine, Dow University of Health Sciences, Karachi. bader@zuberi.biz
Afsar
Salahuddin
S
Quraishy
Muhammad Saeed
MS