Occult Hepatitis B Virus Infection in a Cohort of Liver Disease Patients with Chronic Hepatitis C: A significant Association of HCV Genotype 1b in South India

Abstract

AIM: Occult hepatitis B virus infection (OHBI) is characterized by low viral replication in the absence of Hepatitis B surface antigen (HBsAg), and although this has been described among people with chronic hepatitis C liver disease in the western world, its prevalence and clinical significance remains unclear in the Indian subcontinent. Hence the present study was carried out to analyse the frequency and clinical outcomes of occult HBV infections among patients with Hepatitis C Virus (HCV) -related chronic liver disease (CLD) and its associations with HCV genotype. METHODS: Hepatitis B Virus DNA by polymerase chain reaction (PCR) in serum samples of 260 HBsAg negative subjects with chronic HCV related liver disease, and in 70 apparently healthy volunteers who were negative for both HBsAg and HCV antibody was investigated. Serum samples reactive by at least two independent PCR assays were considered HBV DNA positive. RESULTS: HBV-DNA was detected among 19 of the subjects with HCV-related chronic liver disease (CLD) (7.3%), which was significantly higher (p=0.2) than the rate found among the controls (4.3%). HBV occult infection was more frequent (37.5%) in 24 anti- HBs negative/anti- Hepatitis B core Antigen (anti-HBc) positive patients than in 180 anti-HBs/anti-HBc positive (5 %, p<0.05). HCV RNA positivity by qualitative PCR was significantly (p<0.001) higher among subjects with occult HBV infection compared to those without occult HBV infection. Further, HCV genotype 1b was predominantly associated with occult HBV (73%), especially among subjects with hepatocellular carcinoma (HCC) (p<0.05) as compared to non-occult HBV cases. CONCLUSION: This study suggests that in areas endemic for HBV infection, in patients with HCV, especially of genotype 1b, occult HBV should be considered and HBV DNA testing should be performed.