Asian Ethnicity May Predict Hep B-Dominant Dual Infection

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Asian Ethnicity May Predict Hep B-Dominant Dual Infection

Last Updated: April 07, 2011.

THURSDAY, April 7 (HealthDay News) -- Asians who are infected with both

hepatitis B virus (HBV) and hepatitis C virus (HCV) are more likely to have

HBV-dominant disease, compared to dually infected non-Asians, according to a

study published online March 21 in Hepatology.

Long H. Nguyen, of the Stanford University School of Medicine in California, and

colleagues investigated the characteristics of patients infected with both HBV

and HCV in a large, multiethnic cohort in the United States. Using HBV DNA, HCV

RNA, and alanine aminotransferase (ALT) levels, 115 patients with HBV/HCV dual

infection were identified and matched to 115 monoinfected HBV patients. The

study team compared demographic, clinical, and viral characteristics of dual and

monoinfection.

The researchers found that both groups had similar clinical characteristics: 68

percent male, 83 percent Asian, and age 52±14 years, with median follow-up of 33

to 38 months. The proportion of monoinfected and dual infected patients with ALT

above 40 U/L was similar, both at baseline and during follow-up. HBV/HCV

co-dominance was rarely seen in patients with dual infection at baseline or

follow-up; patients with HBV viremia had low or absent HCV RNA, and patients

with detectable HCV RNA had low or absent HBV DNA. Asian ethnicity independently

predicted HBV dominance. Significantly more monoinfected patients were treated

with HBV antiviral therapy (43 percent versus 24 percent of dual infected

patients).

" Our findings may suggest that ethnicity may predict for the dual infection

viral dominance profile, more specifically that Asian ethnicity is an

independent predictor for HBV-dominated dual infection, " the authors write.

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http://onlinelibrary.wiley.com/doi/10.1002/hep.24308/abstract

Ethnic differences in viral dominance patterns in patients with hepatitis B

virus and hepatitis C virus dual infection†

Long H. Nguyen1,2, Steve Ko1, Shane S. Wong1, Pelu S. Tran1, Huy N. Trinh MD2,3,

Ruel T. MD2,3, Aijaz Ahmed MD4, Glen A. Lutchman MD4, Emmet B. Keeffe

MD4, Mindie H. Nguyen MD, MAS4,*,‡DOI: 10.1002/hep.24308

Copyright © 2011 American Association for the Study of Liver Diseases

Issue

Hepatology

Accepted Article (Accepted, unedited articles published online for future

issues)

Abstract

Background and Aims:

Studies of HBV/HCV dual infection are limited. Most are small, conducted outside

the U.S., and compare dual infection with HCV monoinfection. The goal of this

study was to characterize HBV/HCV dual infection in a large multiethnic,

matched, case-control study of dual infected and HBV-monoinfected patients at

two U.S. centers.

Methods:

Using ICD-9 electronic query and chart review, we identified 115 HBV/HCV dual

infection patients with serial HBV DNA, HCV RNA, and ALT levels. As a control,

115 monoinfected HBV patients were chosen randomly and matched to cases by

age±10 years, gender, Asian vs. non-Asian ethnicity, and study site.

Results:

Both groups had similar gender, ethnic, and age distributions: 68% male, 83%

Asian, and age 52±14 years. Median follow-up was 33-38 months. More monoinfected

patients received HBV antiviral therapy than dual infected patients (43% vs.

24%, P= 0.002). No significant difference was detected between the proportion of

monoinfected vs. dual infected patients with ALT above 40 U/L at presentation or

during follow-up. Dual infection patients exhibited very little HBV/HCV

codominance at baseline and throughout follow up: patients had either HBV

viremia with low or absent HCV RNA or detectable HCV RNA with low or absent HBV

DNA. Asian ethnicity was predictive of HBV dominance after adjusting for gender,

age, and baseline ALT elevation (OR = 7.35, P= 0.01).

Conclusion:

HBV/HCV dual infected and HBV monoinfected patients generally had similar

clinical characteristics. Asian ethnicity is a major independent predictor of

HBV-dominant disease, and HCV dominance with undetectable HBV DNA is more common

in non-Asians. Larger studies are needed to further characterize the natural

history of HBV/HCV dual infection in Asians and non-Asians. (Hepatology 2011.)