Long‐term outcome of hepatitis B and hepatitis C virus co‐infection and single HBV infection acquired in youth

Department of Internal Medicine and Hepatology, Second University of Naples, Naples, Italy.
Journal of Medical Virology (Impact Factor: 2.35). 12/2009; 81(12):2012-20. DOI: 10.1002/jmv.21560
Source: PubMed


Co-infection with HBV and HCV seems to be associated with more severe liver disease in retrospective and cross-sectional studies in adults, but no data are available when co-infection is acquired in youth. The long-term outcome of infection acquired in youth was assessed in patients co-infected with HBV and HCV and in patients with HBV infection only. Twenty-seven patients with HBV and HCV co-infection and 27 patients infected with HBV only were enrolled. Seventy-six per cent of the patients were treated with alpha-interferon for 1 year. After a median follow-up of 23 years, the annual progression rate of fibrosis was 0.07 in patients co-infected with HBV and HCV, and in those infected with HBV it was 0.07 and 0.11 (P < 0.004) for HBe and anti-HBe-positive patients, respectively. In co-infected patients, the development of cirrhosis was observed in 2 (7.4%) and of hepatocellular carcinoma (HCC) in 1 (3.7%), while in those with HBV, cirrhosis appeared in one patient (3.7%). Alcohol intake (OR = 9.5 +/- 1.2; 95% CI = 6.6-13.9; P < 0.0001) was independently associated with cirrhosis and HCC. alpha-interferon showed no efficacy during treatment, but the treated group showed higher HCV RNA clearance during post-treatment follow-up. Co-infection with HBV and HCV and single HBV infection acquired in youth showed a low rate of progression to liver fibrosis, no liver failure, and low development of HCC during a median follow-up of 23 years (range 17-40).

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    • "Open Access group.bmj.com on August 14, 2013 -Published by bmjopen.bmj.com Downloaded from Table 2 Continued Study, year (reference) Median/mean age (years) Proportion of men (%) Proportion with cirrhosis (%) Proportion with elevated ALT (%) Proportion positive for HBeAg (%) HBeAg seroconverters (n, %) IIHCSG, 1998 45 I 54 C 54 64 100 NS NS NS Ikeda et al, 1998 46 I 41 C 44 79 100 NS 52 NS Lin et al, 2001 47 I 39 C 41 95 10 100 0 NA Lin et al, 2007 48 I 32 C 31 94 9 NS 100 I 115, 49 C 86, 37 Mahmood et al, 2005 50 I 49 C 49 69 100 NS 36 NS Manolakopoulos et al, 2004 26 I 65 C 63 80 100 100 0 NA Matsumoto et al, 2005 51 I 42 C 41 73 18 NS 55 NS Niederau et al, 1996 54 I 40 C 41 78 28 100 100 I 53, 51 C 7, 13 Romeo et al, 2009 57 NS 77 35 NS 27 NS Tangkijvanich et al, 2001 58 I 37 C 40 72 20 NS 100 I 24, 36 C 7, 10 Tong et al, 2009 60 I 46 C 46 86 100 14 53 NS Truong et al, 2005 61 I 33 C 37 53 2 100 60 I 9, 53 C 11, 55 Yuen et al, 2001 64 I 27 C 28 64 NS 32 100 I 96, 46 C 93, 46 Yuen et al, 2004 65 I 43 C 43 71 NS NS 23 NS Yuen et al, 2007 66 I 34 C 33 74 0 48 100 NS Zampino et al, 2009 67 NS 67 0 NS 54 I 16, 62 "
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    ABSTRACT: The effect of antiviral therapy on clinical outcomes in chronic hepatitis B virus (HBV) is not established. We aimed to assess the effects of interferon and/or nucleos(t)ide analogues versus placebo or no intervention on prevention of hepatocellular carcinoma (HCC) and mortality in chronic HBV. Random-effects pairwise meta-analysis of randomised trials and observational studies. Electronic and manual searches were combined. Randomised controlled trials (RCTs) were included in the primary analyses. Observational studies were included in sensitivity analyses. The primary outcome measures were HCC incidence and mortality. The secondary outcome measure was HCC mortality. We included 8 RCTs, 8 prospective cohort studies and 19 case-control studies with a total of 3433 patients allocated to antiviral therapy and 4625 controls. The maximum duration of follow-up was 23 years. Randomised trials found no effect of antiviral therapy on HCC or mortality. Cohort studies found that antiviral therapy increased the risk of HCC (risk ratio 1.43; 95% CI 1.06 to 1.95), whereas case-control studies found a decreased risk of HCC in the intervention group (risk ratio 0.69; 95% CI 0.54 to 0.88). There was a clear difference between the results of RCTs and observational studies (test for subgroup differences, p<0.001). Antiviral therapy did not affect mortality in cohort studies, but reduced mortality in case-control studies (relative risk 0.71; 95% CI 0.54 to 0.93; test for subgroup differences, p=0.406). The effect of antiviral therapy on clinical outcomes in HBV remains to be established. Although there was a positive effect in the sensitivity analyses, the strength of the evidence does not allow for extrapolation to clinical practice as research design plays an essential role in the overall assessment. Prospero number CRD42013003881.
    BMJ Open 08/2013; 3(8). DOI:10.1136/bmjopen-2013-003265 · 2.27 Impact Factor
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    • "While studies varied in the order of risk for hepatitis B or C monoinfection, co-infection was relatively consistently associated with greater incidence of HCC and lower survival than mono-infection. In their 23 year follow up study, Zampino et al. [23] found that earlier age at infection was associated with a lower disease progression in both mono- and co-infected patients. "
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    ABSTRACT: Background Many countries have developed, or are developing, national strategies aimed at reducing the harms associated with hepatitis C infection. Making these strategies relevant to the vast majority of those affected by hepatitis C requires a more complete understanding of the short and longer term impacts of infection. We used a systematic approach to scope the literature to determine what is currently known about the health and psychosocial impacts of hepatitis C along the trajectory from exposure to ongoing chronic infection, and to identify what knowledge gaps remain. Methods PubMed, Current Contents and PsychINFO databases were searched for primary studies published in the ten years from 2000–2009 inclusive. Two searches were conducted for studies on hepatitis C in adult persons focusing on: outcomes over time (primarily cohort and other prospective designs); and the personal and psychosocial impacts of chronic infection. All retrieved studies were assessed for eligibility according to specific inclusion/exclusion criteria, data completeness and methodological coherence. Outcomes reported in 264 included studies were summarized, tabulated and synthesized. Results Injecting drug use (IDU) was a major risk for transmission with seroconversion occurring relatively early in injecting careers. Persistent hepatitis C viraemia, increasing age and excessive alcohol consumption independently predicted disease progression. While interferon based therapies reduced quality of life during treatment, improvements on baseline quality of life was achieved post treatment – particularly when sustained viral response was achieved. Much of the negative social impact of chronic infection was due to the association of infection with IDU and inflated assessments of transmission risks. Perceived discrimination was commonly reported in health care settings, potentially impeding health care access. Perceptions of stigma and experiences of discrimination also had direct negative impacts on wellbeing and social functioning. Conclusions Hepatitis C and its management continue to have profound and ongoing impacts on health and social well being. Biomedical studies provided prospective information on clinical aspects of infection, while the broader social and psychological studies presented comprehensive information on seminal experiences (such as diagnosis and disclosure). Increasing the focus on combined methodological approaches could enhance understanding about the health and social impacts of hepatitis C along the life course.
    BMC Public Health 08/2012; 12(1):672. DOI:10.1186/1471-2458-12-672 · 2.26 Impact Factor
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