Hepatitis C and B co-infection

There is not a great deal of research on hepatitis C and B co-infection, therefore we have no accurate figures on how many people living with both hepatitis C and B are living in Australia.  However, it appears that such co-infection is not uncommon, especially in countries where hepatitis B is common.

It is possible to contract both viruses at the same time or a person with one virus may be infected with the other at a later time as both viruses are transmitted through blood-to-blood contact.

Co-infection with both hepatitis B and hepatitis C may lead to more severe liver disease, including cirrhosis and/or liver failure, and increases the risk of developing liver cancer.

Testing for hepatitis B and C

Co-infection with hepatitis C and B can be difficult to diagnose due to the interaction of the viruses which usually leads to one virus becoming dominant over the other. Several studies have shown that either virus can suppress reproduction of the other virus, although it appears that the hepatitis C virus will usually dominate over the hepatitis B virus.

Suppression of one hepatitis virus does not mean that it has been eliminated from the body. It simply means that its effects, or impact, have been slowed or stopped.  But when the dominant virus is treated and either eradicated or suppressed, the suppressed virus may become active again and lead to long-term problems.

Treatment of hepatitis C and hepatitis B co-infection

Treatment of hepatitis B and hepatitis C co-infection follows the same treatment criterias applied to people with hepatitis B or hepatitis C only. The treatment decision is based on which is the dominant hepatitis virus.  Because it is effective against both viruses individually, interferon has been widely studied in the treatment of hepatitis C and B co-infection. In people with hepatitis C dominant disease the standard treatment with interferon and ribavirin has been shown to be effective.

For people with hepatitis B dominant disease, treatment with interferon is a reasonable option.  Lamivudine may be included in this treatment regime.  At this time, there is little information available regarding treatment of hepatitis B dominant co-infection with adefovir and entecavir.

Treating co-infection must be approached cautiously because reactivation of the non-dominant virus may result in flares (high virus activity) of that virus may occur.

References

This information was adapted from the Hepatitis Australia website.

Dore, G. & Sasadeusz, J. (Eds) (2006). Coinfection: HIV & Viral hepatitis a guide for clinical management. ASHM.

Filippini, P., Coppola, N., Scolastico, C. et al. Does HIV infection favour the sexual transmission of hepatitis C? Sexually Transmitted Diseases 2001; 28:725–729.

Ghosn, J., Pierre-Francois, S., Thibault, V. et al. Acute hepatitis C in HIV-infected men who have sex with men. HIV medicine 2004; 5:303–306.

Serpaggi, J., Chaix, M-L., Batisse, D. Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV-1 infected men and inefficiency of early antiviral therapy. AIDS 2006; 20:233–240.

Crockett, S.D. and Keeffe, E.B. Natural history and treatment of hepatitis B virus and hepatitis C virus coinfection. Annals of Clinical Microbiology and Antimicrobials 2005: http://www.ann-clinmicrob.com/contents/4/1/13.

Liu, C.J., Chen, P.J., Lai, M.Y. et al. (2003). Ribavirin and interferon is effective for hepatitis C virus clearance in hepatitis B and C dually infected patients. Hepatology. 37: 568-567.

Page last updated: Wednesday 15 September, 2010