title: Hepatitis B Surface Antigen Loss and Hepatocellular Carcinoma Development in Patients With Dual Hepatitis B and C Infection.
abstract: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are 2 major causes of chronic viral hepatitis. It is still unclear how HCV coinfection affects HBV replication and clinical outcomes in HBV/HCV coinfected patients.We conducted a longitudinal study, which enrolled 111 patients with HBV/HCV coinfection and 111 propensity score-matched controls with HBV monoinfection. Both groups had comparable baseline age, sex, fibrosis stage, levels of HBV DNA, and HBV surface antigen (HBsAg). The HCV coinfection and other host/viral factors were correlated with various outcomes, including HBsAg loss and cirrhosis/hepatocellular carcinoma (HCC) development.After a 10-year follow-up, we found that HCV coinfection itself was not associated with HBsAg loss. However, coinfected patients with alanine aminotransferase (ALT) level >80 U/L had a higher chance of HBsAg loss than those with ALT level ≤80 U/L [hazard ratio (95% confidence interval): 4.41 (1.75-11.15)] or matched controls with HBV monoinfection [hazard ratio (95% confidence interval): 3.40 (1.54-7.50)]. Besides, both HCV coinfection and higher ALT levels were associated with higher HCC risks and the HCC risks remained even after HBsAg loss in HBV/HCV con-infected patient.HCV coinfection is not associated with HBsAg loss. A higher ALT level is a major determinant of HBsAg loss in patients with HBV/HCV coinfection. Both HCV coinfection and a higher ALT level were independent risk factors of HCC.
authors.affiliation: From the Division of Gastroenterology (T-CT, C-CW), Department of Internal Medicine, Taipei Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation; Division of Gastroenterology (H-CY, T-HS, C-HL, P-JC, C-JL, J-HK), Department of Internal Medicine; Graduate Institute of Clinical Medicine (C-LC, T-HS, C-HL, C-JL, J-HK); Hepatitis Research Center (W-TY, C-HL, J-HK); Department of Medical Research (J-HK); Department of Microbiology (H-CY), National Taiwan University College of Medicine and National Taiwan University Hospital; Master of Public Health Degree Program (W-TY), National Taiwan University, Taipei; Division of Gastroenterology (L-WW), Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei; School of Medicine (T-CT, C-CW), Tzu Chi University, Hualien; Genomics Research Center Academia Sinica (D-SC), Taipei, Taiwan; St Vincent's Hospital (SF-TK), Melbourne VIC, Australia; and Taiwan Liver Disease Consortium (TLC) (C-JL), Taipei, Taiwan.
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Yang
authors.forename: Li-Wei
authors.initials: LW
authors.lastname: Wu
authors.forename: Tai-Chung
authors.initials: TC
authors.lastname: Tseng
authors.forename: Chi-Ling
authors.initials: CL
authors.lastname: Chen
authors.forename: Hung-Chih
authors.initials: HC
authors.lastname: Yang
authors.forename: Tung-Hung
authors.initials: TH
authors.lastname: Su
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Stephanie Fang-Tzu
authors.initials: SF
authors.lastname: Kuo
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Liu
authors.forename: Pei-Jer
authors.initials: PJ
authors.lastname: Chen
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000276:immunology* / Q000473:pathology; D060085:Coinfection; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006509:Hepatitis B / Q000150:complications / Q000276:immunology* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology*; D006526:Hepatitis C / Q000150:complications / Q000276:immunology* / Q000821:virology; D018936:Hepatitis C Antigens / Q000276:immunology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens; D018936:Hepatitis C Antigens; D012367:RNA, Viral