By Liz Highleyman

Due to overlapping transmission routes, many individuals are coinfected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). It is not yet clear how these viruses interact in the body -- though studies suggest that they may inhibit each other -- or how best to treat combined infection.

In a study published in the November 2008 Journal of Hepatology, Andrej Potthoff and colleagues with the HEP-NET B/C Co-infection Study Group analyzed the safety and efficacy of pegylated interferon plus ribavirin in this population.

This prospective multicenter pilot study included 19 patients with chronic HBV-HCV coinfection, defined as being both hepatitis B surface antigen (HBsAg) positive and HCV RNA positive; 10 had HCV genotype 1 and 9 had genotypes 2 or 3. At baseline, 13 patients were HBV DNA negative.

All participants were treated with weight-adjusted pegylated interferon alfa-2b (PegIntron) plus ribavirin for 48 weeks (for HCV monoinfection, standard therapy is 48 weeks for genotype 1 and 24 weeks for genotypes 2 or 3).

Results

• In an intent-to-treat analysis, 14 participants (74%) achieved HCV virological response.

• 12 patients (63%) experienced a biochemical response (ALT/AST normalization).

• At the end of treatment, as well as at the end of 24-week post-treatment follow-up, the HCV virological response rate was 93% (14 of 15) for patients adherent to therapy:

• 86% for those with genotype 1;

• 100% for those with genotypes 2 or 3.

• 2 of the 5 initially HBV DNA positive patients with available data were HBV DNA negative at 24 weeks of follow-up.

• Conversely, however, 4 initially HBV DNA negative patients became HBV DNA positive after HCV clearance.

Based on these findings, the study authors concluded, "Combination therapy with [pegylated interferon alfa-2b] and ribavirin is highly effective in inducing a virological response concerning HCV in patients with HBV-HCV coinfection."

However, they added, "HBV replication may increase after the clearance of HCV, and thus close monitoring for both the viruses is recommended even in patients with initially undetectable HBV DNA."

10/17/08

References

A Potthoff, H Wedemeyer, WO Boecher, and others. The HEP-NET B/C co-infection trial: A prospective multicenter study to investigate the efficacy of pegylated interferon-?2b and ribavirin in patients with HBV/HCV co-infection. Journal of Hepatology 49(5): 688-694. November 2008. (Abstract).

G Raimondo and C Saitta. Treatment of the hepatitis B virus and hepatitis C virus co-infection: Still a challenge for the hepatologist. Journal of Hepatology 49(5): 677-679. November 2008.