Hepatitis B and Hepatitis C Co-infection

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases worldwide.

Co-infection between the two viruses can be quite common, due to the similar modes of transmissions shared between the two strains.

Many of these coinfections occur through exposure to unsterilized equipment, or through intravenous drug use and the sharing of needles.

 

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Detecting a co-infection

Due to the severity of hepatitis C, this strain can quickly become the ‘dominant’ liver virus, reducing hepatitis B levels to a point where the standardised blood test may fail to detect its presence.

Because of this, it can be difficult to discern the number of those infected with both strains of the virus.

Estimations put the rate of hepatitis C and hepatitis B co-infection between 9% and 30%.

The severity of this co-infection is that the risk of severe liver disease is heightened, alongside the increased risk of progression towards liver cancer.

 

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Treatment of Hepatitis B and Hepatitis C co-infection can represent a challenge.

AASLD recommends starting people with HBV/HCV co-infection, who meet the criteria for treatment of active HBV infection, on therapy at the same time or before starting direct acting antiviral (DAA) for HCV treatment. Patients with low or undetectable HBV DNA levels should be monitored at regular intervals during hepatitis C treatments.

Those requiring treatment for HBV should be placed on therapy based on AASLD’s HBV treatment guidelines.

Those with HCV who have resolved the HBV virus, whether spontaneously resolving the infection or following treatment, should be monitored for HBV reactivation while on DAA therapy.

 

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