Division of Gastroenterology, VA New York Harbor Healthcare System and New York University School of Medicine, 423 East 23rd Street, New York, NY 10010, USA.
Hepatology. 2010 Mar;51(3):759-66. doi: 10.1002/hep.23461.
Little is known about hepatitis B virus (HBV) infection among patients with chronic hepatitis C virus (HCV) infection in the United States. We prospectively enrolled 1,257 patients with chronic HCV infection from two medical centers in New York City. A total of 61.5% (95% confidence interval, 58.8%-64.2%) had evidence of prior exposure to HBV (hepatitis B core antibody-positive), whereas 5.8% (95% confidence interval, 4.5%-7.1%) had dual infection with HBV (hepatitis B surface antigen-positive). Multivariable logistic regression analysis identified age <40 years, Asian race, injection drug use, and a greater number of lifetime sexual partners as independent risk factors for HBV-HCV dual infection. Liver biopsy results in 26 HBV-HCV-infected and 658 HCV-monoinfected patients showed that stage 3 or 4 fibrosis was significantly more common in those with HBV-HCV dual infection (84.6% versus 29.9%; P < 0.001). Patients infected with HBV and HCV had significantly lower median HCV RNA levels (1.3 versus 4.5 x 10(6) copies/mL; P < 0.001) and were less likely to have HCV RNA levels > or =5 x 10(6) copies/mL (12.3% versus 45.4%; P < 0.001) than those who had HCV monoinfection. All five patients with HBV-HCV dual infection who had undetectable HBV DNA levels had HCV RNA levels > or =5 x 10(6) copies/mL.
American patients with chronic HCV infection should be tested for HBV, especially younger patients, Asians, injection drug users, and those with an increased number of lifetime sexual partners. The presence of severe liver disease and HBV-HCV viral interactions in patients with dual infection necessitates careful but aggressive clinical management, although the optimal strategy remains to be determined.
在美国，慢性丙型肝炎病毒（HCV）感染患者中，HBV 感染的情况知之甚少。我们前瞻性地招募了来自纽约市两家医疗中心的 1257 例慢性 HCV 感染患者。共有 61.5%（95%置信区间，58.8%-64.2%）有 HBV 既往暴露的证据（乙型肝炎核心抗体阳性），而 5.8%（95%置信区间，4.5%-7.1%）有 HBV-HCV 双重感染（乙型肝炎表面抗原阳性）。多变量逻辑回归分析确定年龄<40 岁、亚洲人种、注射吸毒和更多的终生性伴侣是 HBV-HCV 双重感染的独立危险因素。在 26 例 HBV-HCV 感染和 658 例 HCV 单感染患者的肝活检结果中，HBV-HCV 双重感染患者的 3 或 4 期纤维化明显更常见（84.6%对 29.9%；P<0.001）。感染 HBV 和 HCV 的患者 HCV RNA 水平中位数明显较低（1.3 对 4.5 x 10(6)拷贝/ml；P<0.001），且 HCV RNA 水平>或=5 x 10(6)拷贝/ml 的可能性较小（12.3%对 45.4%；P<0.001），而 HCV 单感染患者的 HCV RNA 水平>或=5 x 10(6)拷贝/ml。所有 5 例 HBV-HCV 双重感染且 HBV DNA 水平不可检测的患者的 HCV RNA 水平>或=5 x 10(6)拷贝/ml。
美国慢性 HCV 感染患者应进行 HBV 检测，尤其是年轻患者、亚洲人、注射吸毒者和终生性伴侣较多的患者。双重感染患者存在严重的肝脏疾病和 HBV-HCV 病毒相互作用，需要谨慎但积极的临床管理，尽管最佳策略仍有待确定。
