HBV and its Effect on HCV Therapy

Below are 2 studies, presented at AASLD, suggesting that if a person had prior HBV or currently has HBV the benefits from HCV therapy may be impaired. Further research is needed to address this question. Knowledge of baseline presence of HBV or prior HBV may be key factor in predicting response to HCV therapy and how to approach therapy for HCV. Options might include to treat HBV first and HCV second, or to treat HBV & HCV at once.

PRESENCE OF HEPATITIS B VIRUS CORE ANTIBODIES (ANTI-HBC) IN CHRONIC HEPATITIS C PATIENTS IS PREDICTIVE OF A DECREASED END OF TREATMENT RESPONSE (ETR) TO INTERFERON 

Nadeem Ullah, Firdous A Siddiqui, Paul H Naylor, Joseph L Kinzie, Murray N Ehrinpreis, Rene R Peleman, Milton G Mutchnick, Wayne State Univ, Detroit, MI

Patients with combined chronic hepatitis B and C infection have a poorer response to interferon-a compared to those with chronic hepatitis C (CHC) alone. CHC patients with serum hepatitis B core antibody (HBcAb) and negative hepatitis B surface antigen (HBsAg) have been exposed to hepatitis B virus but do not have evidence of active hepatitis B. These patients are, however, often treated for hepatitis C. 

Objective: This retrospective study compared the end of treatment response to interferon-a2b (IFN-a2b) of chronic hepatitis C patients with antibodies to the hepatitis B core protein to patients who were negative for the antibody. 

Methods: This analysis is based on 85 patients with chronic hepatitis C infection treated with IFN-a2b. The treatment algorithm was 3 MU TIW for 12 weeks, followed by either 5 MU TIW or 3 MU TIW for up to 18 months. All patients were positive for hepatitis C serum RNA by RT-PCR and negative for HBsAg. ETR was defined as negative serum HCV RNA at the completion of treatment. 

Results: Of 85 patients, 43 were anti-HBc positive, and 42 were negative. Overall ETR was 12% (10/85 patients). ETR of patients positive for HBcAb was 2% (1/43 patients), while the response for negative HBcAb patients was 21% (9/42). The difference in the ETR between positive and negative HBcAb patients was statistically significant with p=<.01 by Pearson chi-square test. 

Conclusions: The presence of anti-HBc despite the absence of serum HBsAg in patients with chornic hepatitis C is predictive of a decreased ETR to IFN-a2b. 

THE EFFECT OF PRIOR HBV INFECTION ON THE END-OF-TREATMENT RESPONSE (ETR) TO HIGH DOSE INTERFERON IN INDIVIDUALS WITH CHRONIC HEPATITIS C 

Nicola De Maria, Alessandra Colantoni, LOYOLA Univ CHICAGO, Maywood, IL; Lois Friedlander, Precision Therapeutics, Pittsburgh, PA; Gioacchino Leandro, Hospital de Bellis, Castellana Gr Italy; Hawazin Faruki, West Penn Hospital, Pittsburgh, PA; David H Van Thiel, LOYOLA Univ CHICAGO, Maywood, IL

Anti-HCV positive individuals with serum anti-HBc positivity may still carry a silent HBV infection that can be discovered by the presence of detectable HBV-DNA levels in their serum or liver. In such individuals, the presence of a silent HBV infection may alter their ability to clear HCV-RNA from their serum as a result of IFN treatment. The aim of this study was to assess the ability of individuals with anti-HBc serum positivity to clear HCV-RNA from their serum as a result of 6 months IFN treatment at a high dose (5 mU/day), and to compare it to that of individuals without any markers of prior HBV infection. 152 consecutive subjects with chronic HCV-related liver disease and without cirrhosis were considered for the study. All individuals underwent liver biopsy before starting IFN treatment. 40 individuals (26%, anti-HBc+ group) were anti-HBc positive, 25 of these 40 were also anti-HBs positive (anti-HBc+/anti-HBs+ subgroup), while the remaining 112 had no markers of prior HBV infection (anti-HBc- group). The anti-HBc+ and anti-HBc- groups were not different in terms of their age, viral load, virus genotypes, necro-inflammatory and fibrosis scores. Of the 40 subjects in the anti-HBc+ group, 2 had detectable HBV-DNA levels in their serum (5%), and 6 were HBV-DNA positive in their liver (15%, anti-HBc+/HBV-DNA+ subgroup). The end-of-treatment response rate (ETR) in the different groups and subgroups is reported in the table. Anti-HBc negative individuals had a better ETR as compared to the anti-HBc subjects (69% vs 37%, p<0.001). Surprisingly, the ETR in the 6 individuals anti-HBc+/HBV-DNA + was better as compared to that of subjects anti-HBc+/HBV-DNA-. 

In conclusion: 1) HCV positive individuals with evidence of prior HBV infection have an impaired ETR to high dose IFN treatment; 2) this impaired response is not likely to be related to the continued presence of HBV infection in their livers.