Dundee Epidemiology and Biostatistics Unit, Population Health Sciences, University of Dundee, Dundee, U.K.
Department of Gastroenterology, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, U.K.
Department of Medicine for the Elderly, North Middlesex Hospital, London, U.K.
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, U.K.
Health Protection Scotland, Glasgow, U.K.
Liver Transplant Unit, Royal Infirmary Edinburgh, Edinburgh, U.K.
Department of Infectious Diseases, University Hospital Crosshouse, Kilmarnock, U.K.
Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, U.K.
Department of Infectious Diseases, Western General Hospital, Edinburgh, U.K.
The Brownlee Centre, Glasgow, U.K.
Kirkcaldy Hospital, Fife, U.K.
Monklands Hospital, Lanarkshire, U.K.
epartment of Gastroenterology, Queen Elizabeth University Hospital, Glasgow, U.K.
Aberdeen Royal Infirmary, Aberdeen, U.K.
West of Scotland Virology Centre, Glasgow Royal Infirmary, Glasgow, U.K.
Department of Microbiology, Ninewells Hospital and Medical School, Dundee, U.K.
Department of Virology, Aberdeen Royal Infirmary, Aberdeen, U.K.
Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, U.K.
Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed to determine any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive & HBV surface antigen [HBsAg] positive, 1577 HBcAb positive & HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive & HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses adds significantly to evidence which suggests HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritisation of HCV therapy.