Archives
br Funding br Conflict of interest statement br
Funding
Conflict of interest statement
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
Acknowledgements
Introduction
Recent papers have shown that Interferon-free hepatitis C virus (HCV) therapies with direct-acting antiviral agents (DAAs) can induce a reactivation of Ciclopirox ethanolamine virus (HBV) in HCV-treated patients with a concomitant overt or occult HBV infection. This has raised growing interest in the prevalence of HBV serum markers among HCV-RNA-positive subjects, namely hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs) and antibody to HBV core antigen (anti-HBc). DAA-induced HBV reactivation occurs more frequently in HBsAg-positive individuals than in persons with a resolved HBV infection (HBsAg-negative/anti-HBc-positive with or without anti-HBs) [1], [2].
Several studies have reported the prevalence figures of chronic HCV infection among patients with chronic HBV infection [3], [4], [5], [6], [7], [8], whereas little is known on the prevalence of HBV markers in patients with HCV infection. A study performed in the U.S.A. showed that among 1257 HCV-RNA-positive subjects, 5.8% were HBsAg-positive and 58.8% had evidence of prior exposure to HBV [9].
By pooling the data of two prospective national surveys performed in 2001 [10] and 2014 [11] on subjects referring to several liver units for evaluation of chronic liver disease (CLD), we herein provide figures on the prevalence of HBV markers among HCV-RNA-positive subjects in Italy.
Material and methods
Results
Of the 12,405 subjects enrolled, 8304 resulted anti-HCV-positive, and, of these, 6984 (84.1%) were HCV-RNA-positive. After the exclusion of 356 subjects vaccinated against hepatitis B (presence of isolated anti-HBs positivity), the total number of HCV-RNA-positive subjects evaluated in the present study was 6628. The proportion of chronic hepatitis cases was 76.5%, that of liver cirrhosis 19.9%, and that of HCC 3.7% (data not shown). Of these subjects, 191 (2.9%) resulted HBsAg-positive, 540 (8.1%) HBsAg/anti-HBs-negative and anti-HBc-positive, 972 (14.7%) HBsAg-negative and anti-HBc/anti-HBs-positive, 1703 (26.0%) positive for any HBV marker. All HBV markers showed a decreasing prevalence over time, reaching a statistically significant level only for HBsAg-negative subjects with a presence of both antibodies, and for those positive for any HBV marker (Table 1). None of the 191 subjects with an overt infection (HBsAg positive) was a carrier without HBV induced liver disease.
HBsAg-positive subjects were significantly younger (51.7 vs. 56.6 and 54.4 years; p < 0.01) and with a higher male to female sex ratio (3.5 vs. 1.3 and 1.4; p < 0.01) compared to those with isolated anti-HBc or those with a presence of both antibodies. The prevalence of liver cirrhosis was significantly higher than that of chronic hepatitis in subjects positive for HBsAg (4.4% vs. 2.6%, p < 0.01), but not in those positive for other HBV markers. A statistically significant difference (p < 0.01) in educational level and area of birth was observed only in subjects with isolated anti-HBc positivity (Table 2).
Applying the observed prevalence rates to the estimated one million HCV-RNA-positive subjects living in Italy, a number recently provided by a survey among the general population in five Italian metropolitan areas [13], we can hypothesize the potential number of subjects with HBV markers among HCV-RNA-positive subjects in Italy: nearly 30,000 subjects with overt HBV infection (i.e. presence of HBsAg), almost 80,000 with isolated anti-HBc positivity, and 145,000 with a resolved HBV infection (HBsAg-negative and anti-HBc/anti-HBs-positive) (Table 3).
Discussion
The availability of DAA therapy for chronic HCV infection is a milestone in the cure of this disease. These drugs can eliminate the virus in more than 95% of subjects treated, including those with liver cirrhosis and those with HIV co-infection [15].