Sustained hepatitis C virus clearance and increased... : Hepatology (original) (raw)

Viral Hepatitis

Sustained hepatitis C virus clearance and increased hepatitis B surface antigen seroclearance in patients with dual chronic hepatitis C and B during posttreatment follow-up

Yu, Ming-Lung1,†; Lee, Chuan-Mo2,†; Chen, Chi-Ling3; Chuang, Wan-Long1; Lu, Sheng-Nan2; Liu, Chen-Hua3; Wu, Shun-Sheng4; Liao, Li-Ying5; Kuo, Hsing-Tao6; Chao, You-Chen7; Tung, Shui-Yi8; Yang, Sien-Sing9; Kao, Jia-Horng3; Su, Wei-Wen4; Lin, Chih-Lin5; Yang, Hung-Chih3; Chen, Pei-Jer3; Chen, Ding-Shinn3; Liu, Chun-Jen3,*,‡ for the Taiwan Liver-Net Consortium

1_Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital and Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan_

2_Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan_

3_Graduate Institute of Clinical Medicine, Department of Internal Medicine and Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan_

4_Changhua Christian Hospital, Changhua, Taiwan_

5_Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan_

6_Chi Mei Medical Center, Tainan, Taiwan_

7_Tri-Service General Hospital, Taipei, Taiwan_

8_Chai-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan_

9_Cathay General Hospital, Taipei, Taiwan_

*M.D., Ph.D., Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, 1 Chang-Te Street, Taipei 10002, Taiwan

Email:[email protected]

Received 16 August 2012; Accepted 20 December 2012

View this article online atwileyonlinelibrary.com.

Potential conflict of interest: Nothing to report.

This study was supported in part by grants from the Department of Health, National Science Council (100-2325-B-002-052 and 101-2325-B-002-073, Resource Center, National Research Program for Biopharmaceuticals), Executive Yuan, Taiwan; and National Taiwan University, Taiwan.

Results of this study were presented at the 22nd Conference of the Asian Pacific Association for the Study of the Liver, Taipei, Taiwan, February 16-19, 2012, and at the 47th Annual Meeting of the European Association for the Study of the Liver, Barcelona, Spain, April 18-22, 2012.

†These authors contributed equally to this work.

‡fax: (886)-2-23825962

Abstract

Patients dually infected with hepatitis C virus (HCV)/hepatitis B virus (HBV) have a higher risk of developing advanced liver disease or hepatocellular carcinoma compared with monoinfected patients. Yet, there is a similar rate of sustained virologic response (SVR) after peginterferon alfa-2a and ribavirin combination therapy in these patients compared with HCV-monoinfected patients and a high hepatitis B surface antigen (HBsAg) seroclearance rate. The durability of hepatitis C and B clearance in coinfected patients was investigated in a 5-year follow-up study. Patients with active HCV genotype 1, both HBV-coinfected (n = 97) and HBV-monoinfected (n = 110), underwent 48-week combination therapy with peginterferon alfa-2a plus ribavirin. In patients with active HCV genotype 2 or 3, both HBV-coinfected (n = 64) and monoinfected (n = 50) patients underwent 24-week combination therapy. A total of 295 (91.9%) patients completed treatment and 24 weeks posttreatment follow-up; 264 (89.5%) patients agreed to receive additional follow-up for up to 5 years after the end of treatment. After a median follow-up of 4.6 ± 1.0 years, six of the 232 patients achieving SVR developed HCV RNA reappearance, including five HCV genotype 1/HBV-coinfected patients and one HCV genotype 2/3-monoinfected patient. Subgenomic analysis of the HCV core gene indicated that five patients developed delayed recurrence of HCV infection. Overall, the cumulative recurrence rate of HCV infection was 2.3% (0.4%/year; 95% confidence interval [CI], 0.9%-5.5%). The cumulative HBsAg seroclearance rate was 30.0% (95% CI, 21.5%-42.0%); with 33.1% (95% CI, 21.8%-50.1%) in the 48-week combination therapy group and 24.3% (95% CI, 13.7%-42.9%) in the 24-week therapy group. Conclusion : Peginterferon alfa-2a and ribavirin therapy provides good HCV SVR durability and a high accumulative HBsAg seroclearance rate in patients who are coinfected with HCV and HBV.