Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2023; 29(32): 4900-4911
Published online Aug 28, 2023. doi: 10.3748/wjg.v29.i32.4900
Hepatitis B virus infection in patients with Wilson disease: A large retrospective study
Hua-Ying Zhou, Xu Yang, Kai-Zhong Luo, Yong-Fang Jiang, Wen-Long Wang, Jun Liang, Ming-Ming Li, Hong-Yu Luo
Hua-Ying Zhou, Xu Yang, Kai-Zhong Luo, Yong-Fang Jiang, Wen-Long Wang, Jun Liang, Ming-Ming Li, Hong-Yu Luo, Department of Infectious Diseases, Institute of Hepatology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
Author contributions: Zhou HY, Yang X, and Luo HY contributed to study conception, design and writing of the article; Yang X, Luo KZ, Jiang YF, Wang WL, Liang J, Li MM, and Luo HY contributed to data acquisition, data analysis and interpretation; Zhou HY, Yang X, and Luo HY contributed to editing, reviewing, and final approval of the article; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethical Committee of the Second Xiangya Hospital of Central South University, (2022) Lun Shen [Lin Yan] No. (194).
Informed consent statement: Informed consent was waived by the Ethical Committee of the Second Xiangya Hospital of Central South University.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author luohongyu@csu.edu.cn.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared according to the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Yu Luo, MD, Associate Professor, Department of Infectious Diseases, Institute of Hepatology, The Second Xiangya Hospital, Central South University, No. 139 Renming Road, Changsha 410011, Hunan Province, China. luohongyu@csu.edu.cn
Received: June 4, 2023
Peer-review started: June 4, 2023
First decision: July 8, 2023
Revised: July 20, 2023
Accepted: July 31, 2023
Article in press: July 31, 2023
Published online: August 28, 2023
ARTICLE HIGHLIGHTS
Research background

Although hepatitis B virus (HBV) infection is the most common cause of liver disease in China, the occurrence of HBV infection in Wilson disease (WD) patients and the clinical manifestations of concurrent WD and HBV infections have rarely been reported.

Research motivation

Our study suggests that both WD and HBV infections may coexist. The clinical symptoms of concurrent WD and HBV infections are difficult to distinguish from those of simple viral hepatitis. Therefore, the existence of WD may be hidden. The study of concurrent WD and HBV infection deserves careful consideration.

Research objectives

To investigate the incidence of HBV infection in patients with WD and to analyse how HBV infection affects WD.

Research methods

The clinical data of patients with WD were analyzed retrospectively, and the data of patients with concurrent WD and HBV infection were compared with those of patients with isolated WD. Considering the rarity of the disease, the sample size of the WD patient cohort was very large.

Research results

Among a total of 915 WD patients recruited, the total prevalence of current and previous HBV infection was 2.1% and 9.2% respectively. The main finding of this study was the identification of 19 patients with concurrent WD and chronic hepatitis B (CHB) infection. The mean delay in the diagnosis of WD in patients with concurrent WD and CHB infection was 32.5 mo, which was significantly longer than that in patients with isolated WD (10.5 mo). The rates of severe liver disease and mortality in patients with concurrent WD and CHB infection were significantly higher than those in patients with isolated WD (63.1% vs 19.3%), respectively. Binary logistic regression analysis revealed a significantly higher risk of severe liver disease at the diagnosis of WD in patients with current HBV infection or previous HBV infection than in patients with isolated WD.

Research conclusions

Our study indicates that the prevalence of HBV infection stratified by sex and age in patients with WD is similar to that in the general population. There was a significant delay in the diagnosis of WD in CHB patients. HBV infection is an independent risk factor for severe liver disease in WD patients. WD should be considered and excluded in some patients with CHB infection.

Research perspectives

As we found that previous HBV infection was an independent factor in the exacerbation of WD, the mechanism of which is speculative, future studies could further explore the mechanism by which WD is exacerbated by previous HBV infection and whether it is related to occult HBV infection.