Poor Response to Treatment with Peg-IFN Containing Regimens in Patients Coinfected with Hepatitis B and Hepatitis C Virus

Background and Aims: To investigate the clinical charcteristics and treatment response of patients with chronic coinfection of hepatitis B virus (HBV) and hepatitis C virus (HCV).

Methods: The study included nine consecutive patients with chronic HBV/HCV coinfection. Diagnosis was performed by liver biopsy and/or clinical and laboratory evaluation. Six patients received 48 weeks of pegylated interferon (Peg-IFN) monotherapy or combination therapy with Peg-IFN plus ribavirin according to the dominant virus.

Results: The dominant infection was hepatitis C in six cases. Of the four patients who completed the treatment and follow-up period, only one had a sustained viral response (SVR) to HCV, but unfortunately, this was accompanied by a reactivation of HBV-DNA without flaring of hepatitis. No patient had an HBV-DNA response. Another two patients are still in the follow-up period. One of these patients had an undetectable level of HCV-RNA, and the other had an undetectable level of HBV-DNA at baseline. At the end of treatment, both HBV-DNA and HCV-RNA were negative in these patients. The HBV-DNA-negative patient showed a transient HBV-DNA positivity after clearance of HCV-RNA.

Conclusions: In the majority of HBV/HCV coinfected cases in our sample, HCV was the dominant virus. Currently, the standard treatment regimens are not effective for clearance of HBV and/or HCV. HCV clearance may induce HBV reactivation without flaring of hepatitis.