Reuters Health Information (2004-06-21): Even with undetectable levels, hep B persists in liver with chronic hep C infection
Even with undetectable levels, hep B persists in liver with chronic hep C infection
Last Updated: 2004-06-21 14:45:28 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Hepatitis B virus (HBV) can persist in the liver of patients with chronic hepatitis C without detectable hepatitis B virus DNA in serum, according to a report in the June Journal of Medical Virology.
"Our data suggest that the overall prevalence of HBV infection is higher than that known at present, since patients may have HVB-DNA in liver without any other viral marker in serum," lead author Dr. Vicente Carreno from Fundacion para el Estudio de las Hepatitis Virales, Madrid, Spain, told Reuters Health. "Since according to our data, the presence of HBV-DNA in liver accelerates the progression of the histological damage in patients with chronic HCV infection, it seems reasonable to consider vaccination against HBV in patients with chronic hepatitis C."
HBV can persist in the liver in the absence of serum HBV-DNA after self-limited acute hepatitis B, the authors explain, but the prevalence and impact of occult HBV infection in patients with chronic hepatitis C (HCV) infection has not been studied.
Dr. Carreno and colleagues used PCR and in situ hybridization to determine the prevalence and histological impact of HBV infection in the livers of patients with chronic HCV infection in whom HBV-DNA was undetectable in serum.
More than a third of patients with chronic HCV infection (37.7%) had intrahepatic HBV-DNA detectable by PCR without detectable serum HVB-DNA by PCR, the authors report.
Patients with and without HBV-DNA in the liver did not differ with respect to clinical and epidemiological characteristics, the report indicates, except that the known duration of HCV infection was shorter in patients with HBV-DNA detectable in the liver.
Among patients whose HCV infection duration was shorter than 20 years, biopsies from those with HBV-DNA in the liver had a higher fibrosis score and tended to have a higher necroinflammatory index than did biopsies from HBV negative patients, the researchers note. Such differences were not evident in patients with longer HCV infection durations.
The known duration of HCV infection was significantly shorter in patients with a necroinflammatory index of 4 or lower and in patients with a fibrosis score of 2 or lower when isolated intrahepatic HBV-DNA was present, the results indicate.
"Since there are patients with HBV-DNA in liver in the absence of any other HBV marker in serum, the incidence of HBV infection among relatives of these patients should be studied," Dr. Carreno said. "We are now performing an epidemiological study on the family members of patients with chronic hepatitis C and HBV-DNA detectable only in liver."
"We are also analyzing the HBV genome in these patients in comparison with the HBV-DNA found in patients with chronic hepatitis B to determine if mutations in the HBV-DNA are the cause of the lack of detection of the viral genome in the sera of these patients," Dr. Carreno added.
J Med Virol 2004;73:177-186.