Alpha-interferon therapy in chronic hepatitis due to active dual infectionwith hepatitis B and C viruses

Background: Nearly 14% of non-alcoholic chronic liver disease in India is r elated to hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infectio n. There are no clear data available from the literature on the therapeutic management of these patients who often suffer an unfavourable course. Methods: Fourteen consecutive cases of biopsy-proven chronic liver disease fulfilling the following criteria were included: Child's A or B liver disea se, hepatitis B surface antigen positive, HBV-DNA positive, antibody to HCV positive and HCV-RNA positive. Seven patients had chronic liver disease (g roup I), while the remaining seven patients (group II) had additional disor ders (non-Hodgkin's lymphoma (two), acute leukaemia (two), thalassaemia (tw o), chronic renal failure tone). Interferon alpha-2b (IFN) was given in a d ose of 6 MIU thrice weekly for 6 months. Complete response was defined as l oss of HBV-DNA and HCV-RNA at 6 months and sustained response (SR) as the s ustained loss of HBV-DNA and HCV-RNA for more than 6 months during the foll ow-up period. Results: At the end of 6 months, alanine aminotransferase (ALT) levels rema ined unchanged (120 +/- 40 vs 136 +/- 64 IU/L), but six of the seven (86%) patients in group I lost HBV-DNA. All three hepatitis Be antigen (HBeAg)-po sitive patients lost HBeAg with an early flare of AUT (at 45 +/- 12 therapy days). Two of these patients (29%) lost HCV-RNA. Thus, SR was seen in 29%, while HBV-DNA loss was found in 100% during the follow-up period. In group II patients, there was a significant decrease in ALT (308 +/- 14 vs 65 +/- 25 IU/L, P < 0.001), but only three (43%) patients lost HBV-DNA and two (2 9%) lost HCV-RNA. One patient with acute leukaemia and another with renal f ailure had a complete response to IFN, but none of the lymphoma patients sh owed any antiviral response. Conclusions: In chronic hepatitis due to dual infection with HBV and HCV, i nterferon therapy is: (i) safe; (ii) effective (more so in clearing HBV); ( iii) often associated with early ALT flare; and (iv) may be less effective if non-Hodgkin's lymphoma is present. (C) 1999 Blackwell Science Asia Pty L td.