Ethnic differences in viral dominance patterns in patients with hepatitis B virus and hepatitis C virus dual infection†

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

Viral Hepatitis

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.)