The Clinical Presentations And Disease Outcomes Of HBV/HCV Superinfection

Objective: Due to the interference between two viruses, the clinical presentations and prognosis of the patients who were superinfected with hepatitis B virus and hepatitis C virus(HBV/HCV) are usually different from the patients with single hepatotropic virus infection.The aim of our study is to explore the characteristics of the mutual interference between the viruses and disease outcomes of HBV/HCV superinfection, and provide evidence to benefit the diagnose and treatment for the HBV/HCV superinfection.Methods: 30 inpatients with HBV/HCV superinfection were enrolled from November 2002 to December 2013 in the Third Hospital of Hebei Medical University, 59 cases with HBV infection and 54 cases with HCV infection separately from June 2013 to December 2014 in the Third Hospital of Hebei Medical University. All the patients in each group were retrospectively analyzed for the patient’s general conditions(including age, gender), clinical data including albumin(Alb), globulin(Glb), alanine aminotransferase(ALT), aspartate aminotransferase(AST), gamma glutamyl transpeptidase(GGT), total bilirubin(TB) and prothrombin activity(PTA), marks of hepatitis b virus, HBV DNA and HCV RNA viral load and prognosis. Using SPSS13.0 software to analyze data, and P < 0.05 for the difference was statistically significant.Results:1 The comparison of general conditions in different groups. Of all the 30 patients with HBV/HCV superinfection patients, male cases were 23(76.7%), female cases were 7(23.3%), and the age was from 33 to 77 years old and their average age was 54.62±12.36. In the 59 cases with HBV infection group, male cases were 40(67.8%), female cases were 19(32.2%), and the age was from 25 to 81 years old and their average age was 48.24±14.53. Of all the 54 cases with HCV infection patients, male cases were 32(59.3%), female cases were 22(40.7%), and the age was from 21 to 69 years old and their average age was 49.7±14.41. HBV/HCV superinfection group compared with single HBV or HCV infection group, the age and sex were no significantly different.2 The comparison of viral replication conditions in different groups. According to the difference of HBV DNA and HCV RNA quantitative expression, a total of 30 cases with HBV/HCV superinfection patients were divided into four groups: 8 cases(27%) in HBV DNA(+)/HCV RNA(+) group, 7 cases(23%) in HBV DNA(+)/HCV RNA(-) group, 12 cases(40%) in HBV DNA(-)/HCV RNA(+) group, 3 cases(10%) in HBV DNA(-)/HCV RNA(-) group. In the 59 cases with HBV infection group: 47 cases(79.7%) in HBV DNA(+) group, 12 cases(20.3%) in HBV DNA(-). All the 54 patients with HCV infection, the quantitative results of HCV RNA were all positive.3 The comparison of biochemical indexes of blood coagulation indexes in HBV/HCV superinfection group and HBV infection group. HBV/HCV superinfection group compared with HBV infection group: the levels of Glb, TB, ALT, GGT were increased significantly and the level of PTA was decreased obviously,there were all significantly different(Z or t=-2.213,-2.023,-1.992,-2.422 and-4.550, respectively; all P<0.05). The negative rate of HBe Ag in HBV/HCV superinfection group was 50%,which was higher than that in HBV infection group(45%), but there was no significantly different(χ2=0.143, P>0.05). The positive rate of HBV DNA in HBV/HCV superinfection group was significantly lower than that in HBV infection group(χ2=8.279, P<0.05), The HBV/HCV superinfection group was significantly lower than HBV infection group on the viral load distribution(Z=-3.567, P<0.01).4 The comparison of biochemical indexes of blood coagulation indexes in HBV/HCV superinfection group and HCV infection group. HBV/HCV superinfection group compared with HCV infection group: the levels of Glb, TB, AST, ALT, GGT were increased significantly and the levels of Alb, PTA were decreased obviously,there were all significantly different(Z or t=-2.273,-2.064,-3.983,-5.588,-3.315,-3.4 and 3.315, respectively; all P<0.05). The HBV/HCV superinfection group was significantly lower than HCV infection group on the viral load distribution(Z=-4.431, P<0.01).5 The comparison of the incidence of liver cirrhosis and its complications in each group. The incidence of severe chronic hepatitis, cirrhosis compensatory and decompensation period(including the merger of ascites, hepatic encephalopathy, hepatorenal syndrome, hepatocellular carcinoma(HCC) and other complications) in HBV/HCV superinfection group was higher than that in HBV infection group(53% vs 33%), there was significantly different.(Z=-3.121, P<0.01). The incidence of severe liver function damage(including severe chronic hepatitis, liver cirrhosis, etc) in HBV/HCV superinfection group was higher than that in HCV infection group(53% vs 12%), which was significantly different(Z=‐5.249, P<0.01).Conclusions:1 Compared with patients with single virus infection, HBV/HCV superinfection patients had more severe liver damage, the incidence of liver cirrhosis was also significantly increased.2 The lower HBV DNA and HCV RNA levels are, the more severe liver damage and poorer prognosis will be in patients with HBV/HCV superinfection.