Impact of past HBV exposure on virological response to combined interferon ribavirin therapy in patients with chronic HCV genotype 4

Abstract

Aim: is to investigate if past exposure to HBV in chronic HCV infection promotes the progression of liver disease and influences Interferon (INF) response or not. Methods: 185 patients with chronic HCV were recruited and randomized into 2 groups, group I was treated with PEG-IFN alfa-2b plus ribavirin and group II with 3 MU/TIW IFN alfa-2b plus ribavirin. All patients had HBsAg negative & patients had HBc Ab positive tested for HBsAb. Patients with HBc Ab (n = 37) were tested for serum HBV DNA. Pretreatment liver biopsy and Immunohistochemistry was performed for detection of HBsAg and HBcAg using monoclonal antibodies. Demographic and laboratory data were collected. Results: 70/185 (38%) patients had Anti-HBc, 37 (20%) had isolated anti-HBc and none of the 37 subjects with isolated anti-HBc had serum HBV DNA. Sustained Viral Response (SVR) was achieved in 32/70 (46%) and 46/115 (40%) in anti-HBc seropositive and seronegative patients respectively, in conventional IFN group SVR was 37% and 39% in past HBV exposed patients and unexposed respectively, in PEG IFN group SVR was 59% and 41% in past HBV exposed patients and unexposed respectively. Among anti-HBc and anti-HBs seropositive patients SVR was 10/12 [83%] and 4/21 [19%] p = 0.004 in PEG and conventional IFN respectively. Marked fibrosis was diagnosed in 20% past HBV exposed patients versus 10% in unexposed patients (p = 0.01). Conclusion: past HBV exposure promotes the progression of liver disease but has no effect on the SVR to antiviral therapy in chronic HCV genotype 4 patients.

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Said, M. , El-Raziky, M. , Abdel-Hamid, M. , Saad, Y. , Hashem, M. , Zakaria, S. , Mohamed, M. and Esmat, G. (2011) Impact of past HBV exposure on virological response to combined interferon ribavirin therapy in patients with chronic HCV genotype 4. Open Journal of Internal Medicine, 1, 38-43. doi: 10.4236/ojim.2011.12010.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Ryan, K.J. and Ray, C.G. (Eds). (2004) Sherris medical microbiology. 4th Edition, McGraw Hill, 551-552.
[2] Lauer, G.M. and Walker, B.D. (2001) Hepatitis C virus infection. New England Journal of Medicine, 345, 41-52. doi:10.1056/NEJM200107053450107
[3] Seeff, L.B. (2002) Natural history of chronic hepatitis. Hepatology, 36, 35-46. doi:10.1053/jhep.2002.36806
[4] Abdel-Aziz, F., Habib, M., Mohamed, M.K., Abdel- Hamid, M., Gamil, F., Madkour, S. et al. (2000) Hepatitis C virus (HCV) infection in a community in the Nile Delta: Population description and HCV prevalence. Hepatology, 32, 111-115. doi:10.1053/jhep.2000.8438
[5] Habib, M., Mohamed, M.K., Abdel-Aziz, F., Magder, L.S., Abdel-Hamid, M., Gamil, F. et al. (2001) Hepatitis C virus infection in a community in the Nile Delta: Risk factors for seropositivity. Hepatology, 33, 248-253. doi:10.1053/jhep.2001.20797
[6] Nafeh, M.A., Medhat, A., Shehata, M., Mikhail, N.N., Swifee, Y., Abdel-Hamid, M. et al. (2000) Hepatitis C in a community in Upper Egypt: I. Cross-sectional survey. American Journal of Tropical Medicine and Hygiene, 63, 236-241.
[7] Medhat, A., Shehata, M., Magder, L.S., Mikhail, N., Abdel-Baki, L., Nafeh, M. et al. (2002) Hepatitis C in a community in Upper Egypt: Risk factors for infection. American Journal of Tropical Medicine and Hygiene, 66, 633-638.
[8] Dusheiko, G.M. (1994) Progress in hepatitis C research. Lancet, 344, 605-606. doi:10.1016/S0140-6736(94)91984-4
[9] McOmish, F., Yap, P.L., Dow, B.C., Follett, E.A., Seed, C., Keller, A.J. et al. (1994) Geographical distribution of hepatitis C virus genotypes in blood donors: An international collaborative survey. Journal of Clinical Microbiology, 32, 884-892.
[10] Mellor, J., Holmes, E.C., Jarvis, L.M., Yap, P.L. and Simmonds, P. (1995) Investigation of the pattern of hepatitis C virus sequence diversity in different geographical regions: Implications for virus classification. The International HCV Collaborative Study Group. Journal of General Virology, 76, 2493-2507.
[11] Quinti, I., el-Salman, D., Monier, M.K., Hackbart, B.G., Darwish, M.S., el-Zamiaty, D. et al. (1997) HCV infection in Egyptian patients with acute hepatitis. Digestive Diseases and Sciences, 42, 2017-2023. doi:10.1023/A:1018897813268
[12] Zekri, A.R., Bahnassy, A.A., Ramadan, A.S., El-Bassuoni, M., Badran, A., Madwar, M.A. (2001) Hepatitis C virus genotyping versus serotyping in Egyptian patients. Infection, 29, 24-26. doi:10.1007/s15010-001-0010-8
[13] Farci, P., Alter, H.J., Wong, D.C., Miller, R.H., Govindarajan, S., Engle, R. et al. (1994) Prevention of hepatitis C virus infection in chimpanzees after antibody- mediated in vitro neutralization. Proceedings of the National Academy of Sciences of the United States of America, 1, 7792-7796. doi:10.1073/pnas.91.16.7792
[14] Weltman, M.D., Brotodihardjo, A., Crewe, E.B., Farrell, G.C., Bilous, M., Grierson, J.M. et al. (1995) Coinfection with hepatitis B and C or B, C and delta viruses results in severe chronic liver disease and responds poorly to interferon-alpha treatment. Journal of Viral Hepatitis, 2, 39-45. doi:10.1111/j.1365-2893.1995.tb00070.x
[15] Liaw, Y.F. (1995) Role of hepatitis C virus in dual and triple hepatitis virus infection. Hepatology, 22, 1101- 1108.
[16] Fukuda, R., Ishimura, N., Niigaki, M., Hamamoto, S., Satoh, S., Tanaka, S. et al. (1999) Serologically silent hepatitis B virus coinfection in patients with hepatitis C virus-associated chronic liver disease: Clinical and virological significance. Journal of Medical Virology, 58, 201-207. doi:10.1002/(SICI)1096-9071(199907)58:3<201::AID-JMV3>3.0.CO;2-2
[17] Mrani, S., Chemin, I., Menouar, K., Guillaud, O., Pradat, P., Borghi, G. et al. (2007) Occult HBV infection may represent a major risk factor of non-response to antiviral therapy of chronic hepatitis C. Journal of Medical Virology, 79, 1075-1081. doi:10.1002/jmv.20943
[18] Miura, Y., Shibuya, A., Adachi, S., Takeuchi, A., Tsuchihashi, T., Nakazawa, T. et al. (2008) Occult hepatitis B virus infection as a risk factor for hepatocellu- lar carcinoma in patients with chronic hepatitis C in whom viral eradication fails. Hepatology Research, 38, 546-556. doi:10.1111/j.1872-034X.2007.00316.x
[19] Branco, F., Mattos, A.A., Coral, G.P., Vanderborght, B., Santos, D.E., Franca, P. et al. (2007) Occult hepatitis B virus infection in patients with chronic liver disease due to hepatitis C virus and hepatocellular carcinoma in Brazil. Arquivos de Gastroenterologia, 44, 58-63. doi:10.1590/S0004-28032007000100013
[20] Liang, T.J., Blum, H.E. and Wands, J.R. (1990) Characterization and biological properties of a hepatitis B virus isolated from a patient without hepatitis B virus serologic markers. Hepatology, 12, 204-212.
[21] Zhang, Y.Y., Hansson, B.G., Kuo, L.S., Widell, A. and Nordenfelt, E. (1993) Hepatitis B virus DNA in serum and liver is commonly found in Chinese patients with chronic liver disease despite the presence of antibodies to HBsAg. Hepatology, 17, 538-544. doi:10.1002/hep.1840170403
[22] Cacciola, I., Pollicino, T., Squadrito, G., Cerenzia, G., Orlando, M.E. and Raimondo, G. (1999) Occult hepatitis B virus infection in patients with chronic hepatitis C liver disease. New England Journal of Medicine, 341, 22-26. doi:10.1056/NEJM199907013410104
[23] Zignego, A.L., Fontana, R., Puliti, S., Barbagli, S., Monti, M., Careccia, G. et al. (1997) Relevance of inapparent coinfection by hepatitis B virus in alpha interferon- treated patients with hepatitis C virus chronic hepatitis. Journal of Medical Virology, 51, 313-318.
[24] Kamel, M.A., Miller, F.D., El Masry, A.G., Zakaria, S., Khattab, M., Essmat, G., et al. (1994) The epidemiology of Schistosoma mansoni, hepatitis B and hepatitis C infection in Egypt. Annals of Tropical Medicine and Parasitology, 88, 501-509.
[25] El-Sayed, N.M., Gomatos, P.J., Rodier, G.R., Wierzba, T.F., Darwish, A., Khashaba, S. et al. (1996) Seropre- valence survey of Egyptian tourism workers for hepatitis B virus, hepatitis C virus, human immuno- deficiency virus, and Treponema pallidum infections: Association of hepatitis C virus infections with specific regions of Egypt. American Journal of Tropical Medicine and Hygiene, 55, 179-184.
[26] Gad, R.R., Males, S., El Makhzangy, H., Shouman, S., Hasan, A., Attala, A. et al. (2008) Predictors of a sustained virological response in patients with genotype 4 chronic hepatitis C. Liver International, 28, 1478-3223.
[27] Abdel-Hamid, M., Edelman, D.C., Highsmith, W.E. et al. (1997) Optimization, assessment, and proposed use of a direct nested reverse transcribtion-polymease chain reaction protocol for the detection of hepatitis C virus. Journal of Human Virology, 1, 58-65.
[28] Manns, M.P., McHutchison, J.G., Gordon, S.C., Rustgi, V.K., Shiffman, M., Reindollar, R. et al. (2001) Peginter- feron alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial. Lancet, 358, 958-965. doi:10.1016/S0140-6736(01)06102-5
[29] Fried, M.W., Shiffman, M.L., Reddy, K.R., Smith, C., Marinos, G., Gon?ales, F.L. Jr et al. (2002) Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. New England Journal of Medicine, 347, 975- 982. doi:10.1056/NEJMoa020047
[30] Hadziyannis, S.J. and Koskinas, J.S. (2004) Differences in epidemiology, liver disease and treatment response among HCV genotypes. Hepatology Research, 29, 129- 135. doi:10.1016/j.hepres.2004.02.011
[31] Shobokshi, O.A. (2003) Hepatis C virus genotype 4. Saudi Medical Journal, 24, 79-80.
[32] Alfaleh, F.Z., Hadad, Q., Khuroo, M.S., Algamedi, A., Alashgar, H. et al. (2004) Peginterferon alpha-2b plus ribavirin compared with interferon alpha-2b plus ribavirin for initial treatment of chronic hepatitis C in Saudi patients commonly infected with genotype 4. Liver International, 24, 568-574. doi:10.1111/j.1478-3231.2004.0976.x
[33] Kamal, S.M., El Tawil, A.A., Nakano, T., He, Q., Rasenack, J., Hakam, S.A. et al. (2005) Peginterferon {alpha}-2b and ribavirin therapy in chronic hepatitis C genotype 4: Impact of treatment duration and viral kinetics on sustained virological response. Gut, 54, 858- 866. doi:10.1136/gut.2004.057182
[34] Majda-Stanis?awska, E., Bednarek, M., Jó?wiak, B., Sidorkiewicz, M., Piekarska, A. and Kuydowicz, J.E. (2006) Effect of interferon alfa and ribavirin treatment on hepatitis C virus RNA in serum and peripheral blood mononuclear cells in children with chronic hepatitis C. Acta Gastroenterol Belg, 69, 187-190.

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