Hepatitis C and Hepatitis B Co-infection

Infection with more than one virus is often referred to as co-infection. This section will discuss co-infection with hepatitis C and hepatitis B.

Hepatitis B and hepatitis C co-infection

There is relatively little research on hepatitis B and hepatitis C co-infection, therefore, no accurate figures on the number of people who have both hepatitis viruses is available for Australia. However, it appears that hepatitis B and hepatitis C co-infection is not uncommon, especially in areas where hepatitis B is common, for example, Asia.

Hepatitis B and hepatitis C are both transmitted through blood-to-blood contact, therefore, it is possible to contract both viruses at the same time or a person with one of the viruses may be infected with the other virus at a later time.

Being infected with both hepatitis B and hepatitis C can lead to severe liver disease including cirrhosis and/or liver failure and increases the risk of developing hepatocellular carcinoma (HCC), a form of liver cancer. (Crockett, 2005)

Testing for hepatitis B and hepatitis C
Hepatitis B and hepatitis C co-infection can be difficult to diagnose because when the viruses exist together in the body they can interact with each other, which means that one virus usually becomes dominant over the other. Several studies have demonstrated that the hepatitis C virus can suppress the reproduction of the hepatitis B virus, which can affect the detection of the hepatitis B virus in the blood. Similarly, it has been reported that hepatitis B can also reduce the reproduction of the hepatitis C virus. However, the overall dominant effect appears to be hepatitis C over the hepatitis B virus. (Crockett, 2005)

It is important to remember that suppression of one hepatitis virus does not mean that it has gone from the body. Instead its effects have simply been slowed or stopped, until the dominant virus is treated, after which the suppressed virus could flare up again.

Treatment of hepatitis B and hepatitis C co-infection
Treatment of hepatitis B and hepatitis C co-infection is not well established, therefore, the same treatment criteria is applied to patients who are co-infected as are applied to patients who have either hepatitis B or hepatitis C only. (Liu, 2003)  Deciding which treatment is best for patients with hepatitis B and hepatitis C co-infection should be based on assessing which is the dominant hepatitis virus.

Interferon has been widely studied in the case of hepatitis B and hepatitis C co-infection, because it is effective against both viruses individually. One study showed that using interferon and ribavirin in 24 patients with hepatitis B and hepatitis C co-infection, resulted in a sustained virological response (SVR) of 43%, compared to 60% SVR for patients with hepatitis C only. Therefore, in co-infected patients with hepatitis C dominant disease, treatment with interferon and ribavirin has proven efficacy.

In patients with hepatitis B dominant disease, interferon with or without Lamivudine is a reasonable option. To date, there have not been published studies regarding treatment of co-infected patients with adefovir and entecavir. (Crockett, 2005)

Caution must be exercised in treating patients with co-infection because flares (high virus activity) of the untreated virus may occur as its reproduction is no longer being slowed or stopped by the dominant virus.

Taking care of your liver with hepatitis B and hepatitis C co-infection
People co-infected with hepatitis B and hepatitis C should have their liver function checked regularly by a liver doctor or hepatitis specialist. In addition, avoiding any damage or stress to the liver is vital (refer to the Hepatitis C: Guide to Healthy Living).

Preventing the spread of hepatitis B and hepatitis C
Hepatitis B and hepatitis C can be spread in similar ways. Therefore, it is very important to be blood aware and take precautions to prevent contact with other people’s blood (refer to Preventing the spread of hepatitis C) even if you already have a hepatitis virus.

Most importantly people who have hepatitis C or those who are at risk of being exposed to other people’s blood need to consider being vaccinated against hepatitis A, but most importantly hepatitis B.


References

Crockett, S.D. and Keeffe, E.B. (2005). 'Natural history and treatment of hepatitis B virus and hepatitis C virus co-infection'. Annals of Clinical Microbiology and Antimicrobials.

Liu, C.J., Chen, P.J., Lai, M.Y. et al. (2003). Ribavirin and interferon is effective for hepatitis C virus clearance in hepatitis B and C dually infected patients. Hepatology. 37: 568-567. 

Page Updated: 24 June 2013