HCV genotype and "silent" HBV coinfection: Two main risk factors for a more severe liver disease

To evaluate whether HCV genotype and a "silent" HBV infection may be relate d to a more severe clinical presentation of liver disease, 205 anti-HCV/HCV -RNA positive, HBsAg/anti-HBs negative patients with chronic hepatitis (113 males and 92 females; median age 55 years, range 18-77), were studied on p resentation at the Liver Unit from January 1993 to December 1997. Presence of serum anti-HBc, in the absence of HBsAg and anti-HBs, was considered a m arker of "silent" HBV infection. Of the 205 patients, 134 had undergone per cutaneous liver biopsy. Two main diagnosis groups were established: the mil d liver disease group (76 patients), and the severe liver disease group (10 9 patients); 20 patients who had refused to undergo liver biopsy were not i ncluded in the clinical and virological evaluation because the diagnosis wa s uncertain. The prevalence of severe liver disease was similar in the geno type 1 and non-1 groups (61.3% of 98 patients with genotype 1 and 52.9% of 70 patients with a non-1 genotype). Instead, the 88 patients with "silent" HBV infection showed a higher percentage of severe liver disease than the 9 7 anti-HBc negative patients (72.7% vs. 46.4%, respectively: P <0.0005). Of the 88 anti-HBc positive patients, the prevalence of those with severe liv er disease was similar in the 32 cases with serum HBV-DNA as detected by PC R and in the 56 HBV-DNA negative (81.2% vs. 67.8%, P=0.4). The relation bet ween "silent" HBV infection and severe liver disease was observed both in g enotype 1 and non-1 infected patients. Nevertheless, the anti-HBc negative patients infected by genotype 1 showed a severe liver disease more frequent ly than those infected by a non-1 genotype, with a difference that is signi ficant to the statistical analysis (P <0.05). The findings suggest that "si lent" HBV infection in anti-HCV positive chronic hepatitis enhances the sev erity of the liver disease. Evidence was also found that in patients withou t "silent" HBV infection there is a correlation between the presence of HCV genotype 1 and the severity of liver disease. (C) 2001 Wiley-Liss, Inc.