Overt and hidden coinfection with hepatitis B and C viruses in chronic liver disease and porphyria cutanea tarda

The aim of this study was to assess the rate of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection ("the coinfection") in chronic liver d isease (CLD) and to reveal overt and hidden HBV infection in patients with antibodies to HCV (anti-HCV). A total of 209 untreated patients (64 with ch ronic hepatitis B, 79 with chronic hepatitis C and 66 with porphyria cutane a tarda (PCT)) were screened for serological markers of HBV and HCV infecti on in serum by third generation enzyme-linked immunosorbent assay (ELISA) m ethods and for HBV DNA and HCV RNA in serum by polymerase chain reaction (P CR). The rate of the overt coinfection in chronic hepatitis B was very low (2/64, 3%). However, in chronic hepatitis C, the rate of the hidden coinfec tion with HBV was relatively high (19/79, 24%); these patients had higher a lanine transaminase (ALT) and asparagine transaminase (AST) levels in serum and a more advanced liver disease. In PCT patients, the rates of HBV and H CV infections were the same, 21% (14/66). In the PCT patients infected with HBV or HCV, the rate of the coinfection was 33% (7/21). The PCT patients w ith the coinfection had a high serum ALT level and the worst histological p icture in the liver. The hidden HBV infection was more frequent than the ov ert one. The possibility of the overt or hidden coinfection in CLD renders a detailed analysis of all serum samples for both viruses mandatory. Vaccin ation against HBV infection should be offered to anti-HCV-positive individu als as well as to PCT patients not showing antibodies to HBV (anti-HBV).