title: Primary biliary cirrhosis in HBV and HCV patients: Clinical characteristics and outcome.
abstract: OBJECTIVE
  To present the characteristics, management and outcome of patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infections concurrent with primary biliary cirrhosis (PBC).
  
  
  METHODS
  Since January 2001 to September 2009, we retrospectively evaluated the medical records of all HBV (n = 1493) and HCV patients (n = 526) who are followed in our center for the presence of concurrent PBC. Seventeen patients identified with concurrent viral hepatitis and PBC (8 HCV and PBC; follow-up: 61 ± 37 mo and 9 HBV and PBC; follow-up: 57 ± 38 mo). PBC diagnosis was established if the patients met at least two of the following criteria: positivity for antimitochondrial antibody, elevated cholestatic enzymes and histological lesions of PBC.
  
  
  RESULTS
  HCV or HBV diagnosis preceded that of PBC in most patients by many years. PBC diagnosis was based on the presence of antimitochondrial antibody and elevated cholestatic enzymes in all 17 patients, while one third (5/17; 29.4%) experienced severe pruritus many years before diagnosis. Patients with PBC and HBV were significantly younger at diagnosis of PBC compared to patients with PBC and HCV (56.1 ± 11.2 vs 68.5 ± 10.3, respectively, P < 0.05). At initial clinical and histological assessment the majority of patients were cirrhotics (10/17; 58.8%) with the group of PBC and HCV carrying the highest frequency (87.5% vs 33.3% in PBC and HBV; P < 0.05). The patients with HBV and concomitant PBC seem to have better outcome compared to those with HCV and PBC since none of the 6 non-cirrhotics with HBV and PBC developed cirrhosis during follow-up.
  
  
  CONCLUSIONS
  PBC diagnosis in HBV or HCV patients is very difficult and usually delayed. Therefore, in any case, cholestasis should alert physicians to further search for PBC.
authors.affiliation: Eirini I Rigopoulou, Kalliopi Zachou, Nikolaos K Gatselis, Georgia Papadamou, Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, 41110 Larissa, Greece.
authors.forename: Eirini I
authors.initials: EI
authors.lastname: Rigopoulou
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Zachou
authors.forename: Nikolaos K
authors.initials: NK
authors.lastname: Gatselis
authors.forename: Georgia
authors.initials: G
authors.lastname: Papadamou
authors.forename: George K
authors.initials: GK
authors.lastname: Koukoulis
authors.forename: George N
authors.initials: GN
authors.lastname: Dalekos
keywords: Antimitochindrial antibodies; Autoimmune liver disease; Hepatitis B virus; Hepatitis C virus; Primary biliary cirrhosis.