title: Chronic hepatitis B and liver schistosomiasis: a deleterious association.
abstract: BACKGROUND
  Chronic hepatitis B (CHB) and schistosomiasis are prevalent in several countries, but the impact of this association is unknown. We aimed to investigate the prevalence and morbidity of this co-infection in Minas Gerais, an endemic area of schistosomiasis in Brazil.
  
  
  METHODS
  In total, 406 adults with CHB (HBsAg positive >6 months) were included in a cross-sectional study. CHB was classified as replicative (HBV DNA ≥ 2.000 IU/ml), and low replicative or inactive hepatitis B carriers (HBV DNA <2.000 IU/ml). Schistosomiasis was confirmed by epidemiological and clinical records. Liver biopsies were scored by METAVIR. The risk of severe fibrosis was estimated by multivariate analysis.
  
  
  RESULTS
  Of the 406 patients, 64.8% (263) were male, and the median age was 45 years (IQR 35-54). In total, 57.9% (235) had replicative CHB, and 31.5% (128) had cirrhosis. Schistosoma mansoni was confirmed in 30.5% (124) patients, 81.5% (101) of which were male with a median age of 47 years (IQR 39.5-54). Of the co-infected patients, 61.3% (76) and 38.7% (48) had replicative and inactive CHB, respectively. Schistosomal portal fibrosis (PF) was detected in 69.4% (86/124) patients. Patients with replicative CHB and schistosomal PF had more advanced fibrosis and severe inflammation compared with patients without schistosomal PF (80.8% vs 43.6% for METAVIR F3-F4, p<0.01; 64.0% vs 39.8% for METAVIR A2-A3, p < 0.01). Age >50 years (OR = 1.10; 95% CI 1.06-1.14, p<0.001), male gender (OR = 2.61, 95% CI 1.12-6.09, p = 0.03), schistosomal PF (OR = 4.56, 95% CI 2.10-9.91, p<0.001) and alcoholism (OR = 2.46, 95% CI 1.16-5.19, p = 0.02) were independently associated with cirrhosis.
  
  
  CONCLUSIONS
  The association between replicative CHB and schistosomal PF can be a risk factor for more severe liver disease, which can result in deleterious outcomes for patients from endemic areas.
authors.affiliation: Viral Hepatitis Center, Gastroenterology Unit, Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: J R
authors.initials: JR
authors.lastname: Andrade
authors.forename: Luciana Diniz
authors.initials: LD
authors.lastname: Silva
authors.forename: Camila Mendes
authors.initials: CM
authors.lastname: Guimarães
authors.forename: Eric
authors.initials: E
authors.lastname: Bassetti-Soares
authors.forename: Rodrigo Dias
authors.initials: RD
authors.lastname: Cambraia
authors.forename: O F M
authors.initials: OF
authors.lastname: Couto
authors.forename: Rosângela
authors.initials: R
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D017677:Age Distribution; D001938:Brazil / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D006801:Humans; D008099:Liver / Q000469:parasitology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012555:Schistosomiasis mansoni / Q000453:epidemiology*; D017678:Sex Distribution
keywords: Chronic hepatitis B; Co-infection; Liver fibrosis; Schistosomiasis