Hartl Janine, Ott Claudia, Kirchner Gabriele, Salzberger Bernd, Wiest Reiner
Internal Medicine 1, University Hospital of Regensburg, Germany.
Clin Pract. 2012 Jul 10;2(3):e64. doi: 10.4081/cp.2012.e64. eCollection 2012 May 29.
Dual and triple infections with hepatitis virus C (HCV), B (HBV) and D (HDV) frequently lead to severe liver damage. Hereby we describe a 38-year-old Caucasian male coinfected with HCV (genotype 3a), HBV [positive hepatitis B surface antigen (HbsAg) and antibody to hepatitis B core antigen; negative hepatitis B e antigen (HbeAg) and antibody to hepatitis B e antigen (anti-HBe)] and HDV. Laboratory diagnostics revealed increased liver enzymes and histological examination of the liver showed signs of fibrosis with moderate inflammation. On therapy with pegIFN-α2b and ribavirin HCV-RNA was undetectable at week 8. After week 24 the antiviral therapy was stopped because of a HBs-seroconversion, the loss of HbeAg and the detection of anti-HBe. Furthermore the HCV-RNA was negative. Six months after successful treatment of the triple-infection, HCV- and HDV-RNA and HbsAg remained negative and the liver enzymes had been completely normalized. In conclusion, pegylated-interferon plus ribavirin may be an effective therapy for HCV, HBV and HDV-coinfected patients.
丙型肝炎病毒（HCV）、乙型肝炎病毒（HBV）和丁型肝炎病毒（HDV）的双重和三重感染常导致严重肝损伤。在此，我们描述一名38岁的白种男性，其同时感染了HCV（基因3a型）、HBV [乙肝表面抗原（HbsAg）阳性及乙肝核心抗原抗体阳性；乙肝e抗原（HbeAg）及乙肝e抗原抗体（抗-HBe）阴性]和HDV。实验室诊断显示肝酶升高，肝脏组织学检查显示有纤维化迹象且伴有中度炎症。使用聚乙二醇化干扰素-α2b和利巴韦林治疗后，第8周时检测不到HCV-RNA。第24周后，由于出现乙肝表面抗原血清学转换、HbeAg消失及抗-HBe检测呈阳性，抗病毒治疗停止。此外，HCV-RNA呈阴性。三重感染成功治疗6个月后，HCV-RNA、HDV-RNA及HbsAg仍为阴性，肝酶已完全恢复正常。总之，聚乙二醇化干扰素联合利巴韦林可能是治疗HCV、HBV和HDV合并感染患者的有效疗法。
