Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Hepatol. 2014 Feb;60(2):253-9. doi: 10.1016/j.jhep.2013.09.023. Epub 2013 Oct 2.
BACKGROUND & AIMS: Host and viral factors interplay in the spontaneous clearance of hepatitis C virus (HCV) infection. We aimed to explore the roles of IL28B genotypes and hepatitis B virus (HBV) infections in spontaneous HCV seroclearance.
IL28B rs8099917 genotypes, HCV and HBV markers were determined in 290 patients who were seropositive for HCV antibodies from 1681 total uremic patients on maintenance hemodialysis.
Persistent HCV viremia was observed in 74.6% (214/287) of patients. Logistic regression revealed that the strongest factors associated with spontaneous HCV seroclearance were carriage of rs8099917 TT-type (odds ratio/95% confidence intervals [OR/CI]: 6.22/1.41-27.35, p=0.016), followed by concurrent hepatitis B surface antigen (HBsAg) seropositivity (OR/CI: 2.37/1.06-5.26, p=0.035). The clearance rate was highest among patients with both positive HBsAg/rs8099917 TT-type (44.8%, OR/CI: 20.88/3.5-402.5), followed by positive HBsAg/rs8099917 non-TT-type (28.6%, OR/CI: 8.86/1.8-160.8), and negative HBsAg/rs8099917 TT-type (26.7%, OR/CI: 12.75/1.0-319.4), compared to 4% of negative HBsAg/rs8099917 non-TT-type (trend p=0.0002). HBsAg levels, but not HBV DNA levels, were significantly associated with spontaneous HCV seroclearance. Spontaneous HCV seroclearance rate was 58.3% in patients with HBsAg>200IU/ml/rs8099917 TT-type (OR/CI: 42.54/5.7-908.4), 28.0% in patients with HBsAg<200IU/ml/rs8099917 TT-type or HBsAg>200IU/ml/rs8099917 non-TT-type (OR/CI: 11.12/2.3-201.0), compared to only 3.3% in those with HBsAg<200IU/ml/rs8099917 non-TT-type (trend p=0.0004). Five of 214 (2.3%) HCV viremic patients at enrollment had spontaneous HCV seroclearance during one-year follow-up, which was associated with baseline HCV RNA and HBsAg levels.
High HBsAg levels and favorable IL28B genotype were additively associated with spontaneous HCV seroclearance in uremic patients.
宿主和病毒因素在丙型肝炎病毒（HCV）感染的自发性清除中相互作用。我们旨在探讨 IL28B 基因型和乙型肝炎病毒（HBV）感染在自发性 HCV 血清学清除中的作用。
在 1681 名维持性血液透析的尿毒症患者中，对 290 名 HCV 抗体阳性的患者进行了 IL28B rs8099917 基因型、HCV 和 HBV 标志物的检测。
在 287 例患者中观察到持续性 HCV 病毒血症，占 74.6%（214/287）。Logistic 回归显示，与自发性 HCV 血清学清除相关的最强因素是携带 rs8099917 TT 型（比值比/95%置信区间[OR/CI]：6.22/1.41-27.35，p=0.016），其次是同时存在乙型肝炎表面抗原（HBsAg）阳性（OR/CI：2.37/1.06-5.26，p=0.035）。HBsAg/rs8099917 TT 型阳性患者的清除率最高（44.8%，OR/CI：20.88/3.5-402.5），其次是 HBsAg/rs8099917 非 TT 型阳性（28.6%，OR/CI：8.86/1.8-160.8），HBsAg/rs8099917 TT 型阴性（26.7%，OR/CI：12.75/1.0-319.4），而 HBsAg/rs8099917 非 TT 型阴性（趋势 p=0.0002）的清除率仅为 4%。HBsAg 水平而非 HBV DNA 水平与自发性 HCV 血清学清除显著相关。HBsAg>200IU/ml/rs8099917 TT 型患者的自发性 HCV 血清学清除率为 58.3%（OR/CI：42.54/5.7-908.4），HBsAg<200IU/ml/rs8099917 TT 型或 HBsAg>200IU/ml/rs8099917 非 TT 型患者为 28.0%（OR/CI：11.12/2.3-201.0），而 HBsAg<200IU/ml/rs8099917 非 TT 型患者仅为 3.3%（趋势 p=0.0004）。214 例 HCV 病毒血症患者中有 5 例（2.3%）在一年随访期间自发清除 HCV 血清学，这与基线 HCV RNA 和 HBsAg 水平有关。
在尿毒症患者中，高 HBsAg 水平和有利的 IL28B 基因型与自发性 HCV 血清学清除相关。
