Patients with HCV, occult HBV at greater risk for mortality, HCC, cirrhosis

Squadrito G. J Hepatol. 2013;doi:10.1016/j.jhep.2013.05.043.

  • June 17, 2013

Patients coinfected with chronic hepatitis C and occult hepatitis B were more likely to develop cirrhosis or hepatocellular carcinoma and had poorer survival than patients with hepatitis C alone in a recent study.

In an observational cohort study, researchers tested 326 patients with chronic HCV for occult HBV infection (OBI) between 1991 and 2000. All participants were hepatitis B surface antigen (HBsAg)-negative and underwent liver biopsy. Follow-up for a median of 11 years (range 5-19 years) was performed in 94 patients, including 37 OBI-positive and 57 OBI-negative participants.

Seventy-nine participants received interferon-based HCV therapy, either with or without ribavirin. Sustained virologic response occurred in 26 patients, independently of OBI status.

Hepatocellular carcinoma (HCC) developed in 13 OBI-positive and five OBI-negative participants across a median of 8.8 years (P<.01). In this group, patients with OBI were younger than those without OBI (60 years vs. 74 years; P<.05). Among participants who did not develop HCC, eight OBI-positive and seven OBI-negative participants developed advanced cirrhosis. Worsening liver disease was directly correlated with OBI via the Spearman Correlation Test (P<.001).

Across the entire cohort, 18 participants died and two underwent liver transplantation. All deaths were due to liver-related causes. Cumulative survival rates were shorter (P=.003) and liver-related deaths were more frequent among those with OBI (12 cases vs. six; P<.01). Investigators noted associations between poor survival and HCC development (P<.01) and lack of response to HCV therapy (P=.02).

“The observation that response to anti-HCV therapy (that was not influenced by the OBI status) is associated with a benign evolution of the liver disease, thus possibly nullifying the negative effect of OBI on the liver disease outcome, is of the utmost importance,” the researchers wrote. “Altogether, these data and considerations may lead to the conclusion that, among [chronic HCV] patients, the occult HBV coinfected individuals represent a category at high risk of progression toward cirrhosis, HCC development and lower survival, thus representing a subset of patients in whom curing the HCV infection appears to be a high priority.”