September 25, 2013

Journal of Hepatology
Volume 59, Issue 4 , Pages 696-700, October 2013

Giovanni Squadrito, Irene Cacciola, Angela Alibrandi, Teresa Pollicino, Giovanni Raimondo,

Received 22 August 2012; received in revised form 8 May 2013; accepted 31 May 2013. published online 10 June 2013.

See Editorial, pages 646–647

Abstract

Background & Aims

Occult hepatitis B virus infection (OBI) frequently occurs in patients with hepatitis C virus (HCV) related chronic hepatitis (CHC), but the influence of OBI on the CHC outcome is still uncertain. This observational cohort study evaluated the clinical evolution of CHC patients according to their OBI status.

Methods

From 1991 to 2000, 326 hepatitis B surface antigen negative CHC patients were tested for OBI by the analysis of liver biopsy DNA extracts. A total of 128/326 cases (39.2%) tested OBI positive and 198/326 (60.8%) OBI negative. Ninety-four of 326 patients (37 OBI positive, 57 OBI negative) were followed-up for a median time of 11years (range 5–19years). During the follow-up, 79/94 patients underwent anti-HCV treatments and 26 achieved a sustained virological response that occurred independently of their OBI status.

Results

Eighteen patients (13/37 OBI positive, 5/57 OBI negative, p<0.01) developed hepatocellular carcinoma (HCC). Among the 76 non-HCC individuals, 15 subjects (8/24 OBI positive, 7/52 OBI negative, p<0.05) developed advanced forms of cirrhosis. Eighteen patients died during follow-up and 2 underwent liver transplantation. OBI positive individuals had a cumulative survival rate significantly shorter than OBI negative individuals (p=0.003). Liver-related deaths were more frequently found in OBI positive than OBI negative patients (12/37 OBI positive vs. 6/57 OBI negative patients respectively, p<0.01). Finally, non-response to anti-HCV therapy was significantly associated with lower survival (p=0.02).

Conclusions

Among CHC patients, occult HBV co-infected individuals are a category at high risk of progression toward cirrhosis, HCC development, and lower survival.

Abbreviations: OBI, occult HBV infection, HCV, hepatitis C virus, CHC, chronic hepatitis C, SVR, sustained virological response, HCC, hepatocellular carcinoma, OLT, orthotopic liver transplantation, HBV, hepatitis B virus, HBsAg, hepatitis B surface antigen, IFNα, interferon-α, LDW, liver disease worsening

Keywords: HBsAg-negative, Liver biopsy, HBV DNA, Cirrhosis, Hepatocellular carcinoma

PII: S0168-8278(13)00376-0

doi:10.1016/j.jhep.2013.05.043

© 2013 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

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