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HBV/HCV Coinfection Increased Risk for Multiple Liver Diseases, Death

Veterans coinfected with hepatitis B and hepatitis C virus infection had increased risk for cirrhosis, hepatocellular carcinoma and mortality compared with hepatitis C monoinfected patients, according to study data.

“The effect of HBV coinfection on clinical outcomes in US patients with HCV remains unclear.” The researchers wrote. “We examined the effect of active HBV replication as evidenced by positive HBV DNA on clinical outcomes in coinfected patients, data that may help stratify risks and treatment recommendations for this unique patient population.”

Fasiha Kanwal

Using data from the National Veterans Affairs HCV Clinical Case Registry, researchers, including Fasiha Kanwal, MD, MSHS, and Hashem B. El-Serag, MD, MPH, of Baylor College of Medicine and Michael E. DeBakey VA Medical Center in Houston, identified 98,178 patients with HCV and 1,370 patients with HBV/HCV coinfection. Of the coinfected patients, 49.4% (n=677) had a previous HBV DNA test performed and 44.7% (n=303) of these patients were positive for HBV DNA. Median follow-up was 7.4 years.  

The incidence rate for cirrhosis was higher among coinfected patients compared with HCV monoinfected patients (36.8 vs. 17.4 per 1,000 person-years), as well as incidence of HCC (6.9 vs. 3.6 per 1,000 person-years) and mortality (41.7 vs. 31.4 per 1,000 person-years; P<.05 for all).  

All patients with detectable HBV DNA had a higher risk for cirrhosis (HR=1.89; 95% CI, 1.46-2.45), HCC (HR=2.12; 95% CI, 1.26-3.6) and mortality (HR=1.62; 95% CI, 1.33-1.99) compared with HCV monoinfected patients. However, there were no differences observed in the risk for cirrhosis, HCC or mortality between the patients with undetectable HBV DNA and monoinfected patients.

Hashem B. El-Serag

Multivariate Cox analyses showed that patients coinfected with HBV and HCV with detectable HBV DNA had an 89% higher chance for cirrhosis, 112% higher chance for HCC and 62% higher chance for mortality compared with the monoinfected patients. Patients with undetectable HBV DNA were not at an increased risk for any of these compared with monoinfected patients.

“We found that while only a small number of HCV patients were coinfected with HBV, patients with documented HBV viremia were at a significantly higher risk for cirrhosis, HCC and overall mortality than HCV monoinfected patients,” the researchers concluded. “Patients with HBV and HCV coinfection, therefore, necessitate special attention by physicians and should be triaged for close monitoring and/or antiviral treatment.”

Disclosure: The researchers report no relevant financial disclosures.