5 WORLD GASTROENTEROLOGY NEWS JANUARY 2015 Editorial | Expert Point of View | Gastro 2015: AGW/WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events IFN and RBV worldwide 3. Therefore, HCV seems to be the priority target to be managed in dually infected patients with active hepatitis C. Treatment of hepatitis C in dual HCV/HBV patients with active hepatitis C by Peg-IFN and ribavirin: In the treatment of patients with HCV mono-infection, Peg-IFN in combination with RBV remains the standard of care in many Asian Pacific countries. Our multicenter trial data demonstrated the efficacy of treatment of dually infected patients through Peg-IFN plus RBV 8: for genotype 1 infection, HCV SVR rate was 72.2% in dually infected patients and was 77.3% in mono-infected patients; for genotype 2/3 infections, SVR rate was 82.8% in dually infected patients and 84.0% in mono-infected patients. Durability of HCV responses post-treatment Hepatitis C virus may reappear in 0.9~10% of chronic hepatitis C mo-no- infected patients achieving initial HCV SVR. To clarify this issue, the durability of HCV SVR in the dually infected patients was investigated by a 5-year follow-up study 9. Our results revealed that after a median follow-up of 4.6± 1.0 years, only 6 (2.6%) of the 232 patients achieving SVR developed HCV RNA reappearance. Our data suggested that the HCV SVR was durable in dually infected patients receiving Peg-IFN alfa and ribavirin combination therapy. Clearance of HBsA and HBV reactiva-tion HBsAg clearance at 6 months after end of therapy was found in 18 (11.2%) of the 161 dually infected patients. During 5-year post-treat-ment follow-up, the rate of HBsAg seroclearance was 5.4% per year, reaching 30% at the end of follow-up 9,12. Potential risk for reactivation of HBV DNA during or after treatment of chronic hepatitis C is a major clini-cal concern for in HCV/HBV dually infected patients 2. In our treatment cohort of 76 patients with pre-treatment serum HBV DNA <200 IU/mL, reappearance of HBV DNA was found in 47 (61.8%) patients9. Therefore these patients should be monitored regularly and prompt anti- HBV therapy should be implemented if clinically indicated. Improvement of long-term outcomes post-treatment Whether Peg-IFN and ribavirin com-bination therapy could reduce the risk of HCC or improve survival in HCV/ HBV dually infected patients was evaluated in a large population-based cohort from Taiwan 10. We examined the risk of HCC, mortality, and adverse events in 1,096 treated and 17,562 untreated HCV/HBV dually infected patients. After adjustment, combination therapy significantly reduced the risk of HCC (hazard ratio HR 0.75, 95% confidence interval 95%CI 0.58–0.96), liver-related mortality (HR 0.45, 95% CI 0.35–0.57), and all-cause mortal-ity (HR 0.39, 95%CI 0.32–0.48). Nevertheless, the underlying HBV infection was still a risk factor for HCC and mortality after treatment. Our data demonstrated that combina-tion therapy in addition to control of HCV activity in the short-term, also decreased the risk of developing HCC and improved survival in HCV/HBV dually infected patients 10. Summary and future directions HCV and HBV co-infection is not uncommon in areas endemic for HBV infection and among subjects at risk of parenteral transmission. Thorough se-rological and virological examinations are required to determine the viral dominance as well as to determine the optimal antiviral regimen before the start of anti-viral therapy. For dually infected patients with active hepatitis C, genotype-dependent treatment recommendations for single chronic hepatitis C can be applied 13-15. How-ever, for dually infected patients with active hepatitis B or with established cirrhosis, the optimal regimens await further studies. The clinical applica-tion of new DAA-based triple therapy in this population also remains to be clarified. References 1. Liu CJ, Liou JM, Chen DS, Chen PJ. Natural course and treatment of dual hepatitis B virus and hepa-titis C virus infections. J Formos Med Assoc 2005;104:783-791. 2. Liu CJ, Chen PJ, Chen DS. Dual chronic hepatitis B virus and hepa-titis C virus infection. Hepatol Int 2009;3:517-525. 3. Chen DS. Fighting against viral hepatitis: lessons from Taiwan. Hepatology 2011;54:381-392. 4. Sagnelli E, Coppola N, Messina V, Di Caprio D, Marrocco C, Ma-rotta A, et al. HBV superinfection in hepatitis C virus chronic carri-ers, viral interaction, and clinical course. Hepatology 2002;36:1285- 1291. 5. Liaw YF, Chen YC, Sheen IS, Chien RN, Yeh CT, Chu CM. Impact of acute hepatitis C virus superinfection in patients with chronic hepatitis B virus infection. Gastroenterology 2004;126:1024- 1029. 6. Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carci-noma. Int J Cancer 1998;75:347- 354.
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