HBV superinfection in HCV chronic carriers: A disease that is frequently severe but associated with the eradication of HCV

The impact of hepatitis B virus (HBV) superinfection in hepatitis C virus (HCV) chronic carriers was evaluated in a long‐term follow‐up study on 29 chronic anti‐HCV carriers with acute hepatitis B (AVH‐B) (Case group BC) and 29 anti‐HCV negative patients with AVH‐B (Control group B), pair‐matched for age (±5 years), sex, and risk factors for the acquisition of HBV infection. Patients in Case group BC and those in Control group B showed similar initial HBV viral load and a similar trend of becoming negative for HBV‐DNA. AVH‐B showed a severe course more frequently in Case group BC than in Control group B (34.5% versus 6.9%, P < 0.05). Of the 28 patients in Case group BC alive at the end of the acute illness (one death from liver failure), 24 were followed up for 2‐6 years, median 5 years: 22 patients became HBsAg‐negative and two progressed to HBsAg‐positive chronic hepatitis. HCV‐RNA was undetectable in all patients during AVH‐B; in the 24 patients with a long‐term follow‐up, HCV‐RNA was detected in seven (29.2%) after 1 year, in 14 (58.3%) after 2 years, and in 18 (75%) after 3‐6 years. The six patients who eradicated chronic HCV infection, compared with 18 showing reactivation of HCV replication, had higher values of aspartate aminotransferase and alanine aminotransferase and a higher prevalence of cases with severe AVH‐B (83.3% versus 22.2%, P < 0.05). Conclusions: Although it can be life‐threatening, HBV superinfection in HCV chronic carriers may lead to clearance of chronic HCV infection, especially in patients with severe AVH‐B. (HEPATOLOGY 2009.)