How is coinfection of hepatitis B virus (HBV) and hepatitis C virus (HCV) managed?

Updated: Oct 07, 2019
  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: BS Anand, MD  more...
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Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV), in the absence of human immunodeficiency virus (HIV) infection, is relatively uncommon in the United States, and optimal treatment regimens have not been established. Globally, an estimated 3-18% of hepatitis B surface antigen (HBsAg)-positive individuals have concurrent HCV infection, and these individuals are at a higher risk for hepatocellular carcinoma for unclear reasons. [50]

The World Health Organization recommends offering HCV antibody (anti-HCV) or HBsAg testing, as well as linkage to prevention, care, and treatment services, in all settings to (1) adults and adolescents from populations most affected by HCV infection (ie, population with high HCV seroprevalence, those with a history of and/or high-risk behaviors for HCV exposure) and (2) pediatric, teen, and adult patients clinically suspected to have chronic viral hepatitis. [50]

A few important studies are discussed below.

Villa et al reported that 9 million U of standard interferon (IFN) three times weekly for 3 months could clear HCV in 31% of patients with HCV-HBV coinfection. [133] Using standard IFN and ribavirin, Liu et al discovered that sustained HCV eradication was achieved at rates comparable to those in patients with HCV alone and, interestingly, up to 21% of their patients lost the hepatitis B surface antigen. [134]

Given the superior efficacy of pegylated IFN (PEG-IFN) over standard IFN, Liu et al subsequently conducted a multicenter study using PEG-IFN and ribavirin in HCV-HBC coinfected patients. This regimen proved equally effective in patients with HCV monoinfection and in those with chronic HCV-HBV coinfection. [135]

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