Hepatitis B virus infection among American patients with chronic hepatitis C virus infection: Prevalence, racial/ethnic differences, and viral interactions

Authors

  • Edmund J. Bini,

    Corresponding author
    1. Division of Gastroenterology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY
    • Division of Gastroenterology, VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010
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    • fax: 212-951-3481.

  • Ponni V. Perumalswami

    1. Division of Gastroenterology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY
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  • Potential conflict of interest: Dr. Bini received grants from Schering-Plough, Roche, Intermune, Pharmasset, Bristol-Myers Squibb, GlaxoSmithKline, and Gilead.

Abstract

Little is known about hepatitis B virus (HBV) infection among patients with chronic hepatitis C virus (HCV) infection in the United States. We prospectively enrolled 1,257 patients with chronic HCV infection from two medical centers in New York City. A total of 61.5% (95% confidence interval, 58.8%–64.2%) had evidence of prior exposure to HBV (hepatitis B core antibody–positive), whereas 5.8% (95% confidence interval, 4.5%–7.1%) had dual infection with HBV (hepatitis B surface antigen–positive). Multivariable logistic regression analysis identified age <40 years, Asian race, injection drug use, and a greater number of lifetime sexual partners as independent risk factors for HBV-HCV dual infection. Liver biopsy results in 26 HBV-HCV–infected and 658 HCV-monoinfected patients showed that stage 3 or 4 fibrosis was significantly more common in those with HBV-HCV dual infection (84.6% versus 29.9%; P < 0.001). Patients infected with HBV and HCV had significantly lower median HCV RNA levels (1.3 versus 4.5 × 106 copies/mL; P < 0.001) and were less likely to have HCV RNA levels ≥5 × 106 copies/mL (12.3% versus 45.4%; P < 0.001) than those who had HCV monoinfection. All five patients with HBV-HCV dual infection who had undetectable HBV DNA levels had HCV RNA levels ≥5 × 106 copies/mL. Conclusion: American patients with chronic HCV infection should be tested for HBV, especially younger patients, Asians, injection drug users, and those with an increased number of lifetime sexual partners. The presence of severe liver disease and HBV-HCV viral interactions in patients with dual infection necessitates careful but aggressive clinical management, although the optimal strategy remains to be determined. (HEPATOLOGY 2010.)

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