COINFECTION WITH HEPATITIS-B AND HEPATITIS-C OR B-VIRUS, C-VIRUS AND DELTA-VIRUS RESULTS IN SEVERE CHRONIC LIVER-DISEASE AND RESPONDS POORLY TO INTERFERON-ALPHA TREATMENT

Chronic coinfection with the hepatitis B (HBV) and hepatitis delta (HD V) viruses is known to cause severe liver disease, but the importance of coinfection with hepatitis C virus (HCV) and HBV has not been well documented. In the present study, the clinical and pathological severi ty of liver disease among patients with hepatitis resulting from multi ple viruses was examined and an open trial of the efficacy of interfer on-alpha 2b (IFN-alpha) treatment was conducted. Nineteen patients wit h chronic HBV and HCV infection and 17 with HBV, HCV and HDV infection were studied; 12 in each group underwent liver biopsy. For each coinf ected patient, two patients infected with HCV alone were selected as c ontrols, and these were matched for age and risk factor and were estim ated to have been infected for a similar duration. Coinfection with HB V and HCV or HBV, HCV and HDV was associated with more severe liver di sease than HCV alone (P < 0.01); total Scheuer score, portal and lobul ar inflammation and fibrosis were all worse in coinfected subjects. Ei ght patients with chronic HBV and HCV were treated with recombinant IF N-alpha 2b [3 million units (MU), thrice weekly for 6 months]. Liver f unction tests normalized in two patients and one lost hepatitis B surf ace antigen (HBsAg). Seven patients with hepatitis B, C and delta coin fection were treated with the same regimen and only one normalized ser um alanine aminotransferase (ALT) during (and after) treatment. It is concluded that coinfection with multiple hepatitis viruses is associat ed with histologically more severe liver disease than HCV alone. Short - and long-term responses to doses of IFN-alpha that are used to treat HCV are infrequent, but further studies are required to determine whe ther higher-dose IFN-alpha may benefit patients with combined hepatiti s virus infections.