A recent study investigating the differences in epidemiology, clinical characteristics, and outcomes between patients coinfected with hepatitis B virus (HBV) and hepatitis C virus (HCV) and patients infected with HCV only revealed that coinfected patients experienced a higher incidence of liver cancer and lower sustained virologic response rate.

The study, presented at the American Association of Liver Diseases, was presented by Gwang Hyeon Choi of Seoul National University Bundang Hospital at Seoul National University College of Medicine in Seoul, Korea.

The investigators prospectively enrolled 2,875 patients with HCV RNA positivity at 9 university hospitals in South Korea between May 2007 and June 2020. The patients were classified into 2 cohorts: 1 of 77 patients with both HBV and HCV, and 1 group of 2,798 patients with HCV only. The team collected specific details of patient histories and measured the incidence of liver cancer and overall mortality.

At enrollment, the coinfected cohort contained a higher proportion of male patients (64.9% vs 51.0%, p=0.016); were more likely to consume alcohol (28.6% vs 15.2%, p=0.002); had substantially higher rates of family members with HBV infection (22.1% vs 2.7%, p<0.001); and had greater incidence of past or currently active liver cancer than the HCV group (27.3% vs 11.3%, p<0.002). This cohort also evidenced a significantly lower platelet count (139 vs 161 x1,000/mm³, p=0.008) and higher prothrombin time (INR1.09 vs 1.05, p=0.039) than the group of patients with HCV only.

Both cohorts showed similar HCV RNA levels and distribution of HCV genotype and similar uptake of treatment for HCV. However, the coinfected demonstrated significantly lower sustained virologic response (SVR) after treatment with direct-acting antiviral therapy than did the HCV group (85.0% vs 94.9%, p=0.006).

Among patients without liver cancer at enrollment (53 in the HBV+HCV group and 2,788 in the HCV group), the HBV+HCV group showed significantly higher liver cancer incidence with the unadjusted HR 3.51 ( 95% CI 1.79-6.90, p<0.001) and adjusted HR 4.56 (95% CI 1.87-11.13, p<0.001); however, the cohorts showed similar overall mortality.

“Due to the difference in epidemiological features, a similar treatment uptake with lower sustained virologic response rate, and the higher risk for liver cancer development in the cohort coinfected with HBC-HCV, further studies into the clinical features and outcomes of patients co-infected with both HBV and HCV are warranted,” the authors wrote.

—Allison Casey

Reference:

Choi GH, et al. Clinical features and outcomes of hepatitis C patients co-infected with hepatitis B virus in South Korea: a prospective, multicenter study. Presented at: the American Association for the Study of Liver Disease annual meeting. November 12-15. Virtual.