Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection

doi:10.3748/wjg.v22.i42.9427

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World Journal of Gastroenterology

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World J Gastroenterol. Nov 14, 2016; 22(42): 9427-9436
Published online Nov 14, 2016. doi: 10.3748/wjg.v22.i42.9427

Table 1 Baseline characteristics of 174 patients with chronic hepatitis C virus infection

Variable	Total (n = 174)	Chronic hepatitis (n = 83)	Liver cirrhosis (n = 47)	HCC (n = 44)
Mean age, yr^b^c	66.5 ± 9.9	65.6 ± 9.8	65.3 ± 10.1	69.7 ± 9.3
Male sex	105 (60.3)	54 (65.1)	24 (51.1)	27 (61.4)
Body mass index (kg/m²)	23.3 ± 3.0	23.6 ± 3.0	23.0 ± 3.2	23.0 ± 2.8
Ex or current smoker (n = 173)	51 (29.5)	26 (31.3)	10 (21.7)	15 (34.1)
Alcohol intake (social or heavy) (n = 173)	80 (46.2)	42 (50.6)	17 (37.0)	21 (47.8)
Anti-HBc (n = 100)	75 (75.0)	35 (71.4)	18 (85.7)	22 (73.3)
Hemoglobin (g/dL)^c	13.5 ± 1.8	14.1 ± 1.5	13.5 ± 1.9	12.4 ± 1.9
Platelet (× 103/μL)^a^b	151.3 ± 87.4	188.0 ± 55.7	117.5 ± 120.2	118.3 ± 66.2
Albumin (g/dL)^a^b	4.0 ± 0.5	4.2 ± 0.2	3.8 ± 0.5	3.7 ± 0.5
Total bilirubin (mg/dL)^a	1.0 ± 0.6	1.0 ± 1.7	1.2 ± 0.6	1.1 ± 0.8
ALP (IU/L)^a^b	100.3 ± 47.3	89.2 ± 30.9	102.0 ± 37.0	119.3 ± 71.4
AST (IU/L)^a^b	75.8 ± 103.3	76.0 ± 141.9	72.6 ± 47.8	78.8 ± 45.3
ALT (IU/L)	77.2 ± 138.5	89.7 ± 193.2	68.0 ± 59.3	63.3 ± 41.0
Creatinine (mg/dL)^a	0.9 ± 0.4	1.0 ± 0.5	0.8 ± 0.2	0.9 ± 0.2
Prothrombin time (INR)^a^b	1.1 ± 0.1	1.0 ± 0.1	1.1 ± 0.1	1.1 ± 0.1
AFP > 20 ng/mL (n = 171)^a^b	30 (17.5)	5 (6.2)	9 (19.6)	16 (36.4)
Child-Pugh class (A/B/C)^a^b
A	160 (92.0)	83 (100)	40 (85.1)	37 (84.1)
B	12 (6.9)	0	5 (10.6)	7 (15.9)
C	2 (1.1)	0	2 (4.3)	0
MELD score (n = 167)^a^b	8.5 ± 2.3	8.0 ± 2.3	9.3 ± 2.2	8.9 ± 2.1
HCV genotype (1/2) (n = 135)	60/75	32/35	16/26	12/14 (46.2%/53.8%)
HCV genotype (1/2) (n = 135)	(44.4%/55.6%)	(47.8%/52.2%)	(38.1%/61.9%)	12/14 (46.2%/53.8%)
Antiviral treatment
No antiviral treatment	102 (58.7)	45 (54.2)	25 (53.2)	32 (72.7)
Treatment without SVR	34 (19.5)	14 (16.9)	11 (23.4)	9 (20.5)
Treatment with SVR^b^c	38 (21.8)	24 (28.9)	11 (23.4)	3 (6.8)

Data are presented as mean ± SD or number (%).

^aP value < 0.05 between patients with chronic hepatitis and liver cirrhosis;

^bP value < 0.05 between patients with chronic hepatitis and HCC;

^cP value < 0.05 between patients with liver cirrhosis and HCC. ALP: Alkaline phosphatase; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; MELD: Model for end-stage liver disease; HCV: Hepatitis C virus; AFP: Alpha-fetoprotein; INR: International normalized ratio; SVR: Sustained virologic response.

Table 2 Comparison of clinical factors between patients with and without occult hepatitis B virus infection

Variable	OBI (+) (n = 32)	OBI (-) (n = 142)	P value
Mean age, yr	67.1 ± 9.6	66.4 ± 9.9	0.952
Male sex	19 (59.4)	86 (60.6)	0.527
Body mass index (kg/m²)	23.9 ± 3.2	23.2 ± 3.0	0.180
Anti-HBc (n = 100)	6 (66.7)	69 (75.8)	0.399
Anti-HBs (n = 157)	14 (48.3)	72 (56.3)	0.283
Hemoglobin (g/mL)	13.3 ± 1.3	13.5 ± 1.9	0.364
Platelet (× 10³/mL)	150.5 ± 79.5	151.5 ± 89.3	0.978
Albumin (g/dL)	3.9 ± 0.5	4.0 ± 0.4	0.593
Total bilirubin (mg/dL)	1.1 ± 0.8	1.0 ± 0.5	0.118
AST (IU/L)	62.7 ± 40.3	78.8 ± 112.6	0.546
ALT (IU/L)	54.7 ± 43.5	82.2 ± 151.6	0.148
Creatinine (mg/dL)	0.9 ± 0.2	0.9 ± 0.4	0.779
PT-INR	1.0 ± 0.1	1.0 ± 0.1	0.459
MELD score	8.3 ± 1.9	8.6 ± 2.4	0.744
HCV genotype (1/2)	12/15 (44.4%/55.6%)	48/60 (44.4%/55.6%)	0.587
AFP > 20 ng/mL	6 (19.4)	23 (16.5)	0.441
Child-Pugh class			0.436
A	28 (87.5)	132 (93.0)
B	4 (12.5)	8 (5.6)
C	0	2 (1.3)
Antiviral treatment
No antiviral treatment	21 (65.6)	81 (57.0)	0.430
Treatment without SVR	5 (19.2)	29 (26.4)	0.616
Treatment with SVR	6 (18.8)	32 (22.5)	0.814
Disease progression	7 (21.9)	45 (31.7)	0.392
Development of HCC	3 (11.5)	11 (10.6)	1.000
Follow-up period (mo)	42.5 ± 34.7	36.3 ± 26.9	0.555

Data are presented as mean ± SD or number (%). OBI: Occult hepatitis B virus infection; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; MELD: Model for end-stage liver disease; HCV: Hepatitis C virus; AFP: Alpha-fetoprotein; PT-INR: Prothrombin time-international normalized ratio; SVR: Sustained virologic response.

Table 3 Clinical factors associated with disease progression, defined as development of liver cirrhosis, decompensation, hepatocellular carcinoma, or mortality (n = 174)

Variable	HR	P value	Adjusted HR	P value
OBI	0.494 (0.210-1.164)	0.107	0.510 (0.208-1.251)	0.141
Age (per year)	1.020 (0.990-1.050)	0.194
Male sex	0.935 (0.534-1.636)	0.814
Anti-HBc positivity	2.291 (0.878-5.976)	0.090
AST > 40 IU/L	3.730 (1.740-7.996)	0.001	3.419 (1.117-10.463)	0.031
ALT > 40 IU/L	2.454 (1.273-4.730)	0.007	0.737 (0.297-1.826)	0.510
GGT > 70 IU/L	2.736 (1.571-4.765)	< 0.001
AFP > 20 ng/mL	2.247 (1.238-4.079)	0.008	1.370 (0.721-2.600)	0.336
Child-Pugh score	2.136 (1.628-2.802)	< 0.001	1.716 (1.230-2.394)	0.001
(per unit)	2.136 (1.628-2.802)	< 0.001	1.716 (1.230-2.394)	0.001
MELD score	1.111 (1.009-1.224)	0.032	0.987 (0.860-1.134)	0.856
(per unit)	1.111 (1.009-1.224)	0.032	0.987 (0.860-1.134)	0.856
SVR	0.263 (0.104-0.663)	0.005	0.317 (0.121-0.828)	0.019
HCV genotype 1	1.465 (0.780-2.753)	0.231

Disease progression defined as: (1) occurrence of liver cirrhosis, hepatocellular carcinoma (HCC), decompensation, or mortality in patients with chronic hepatitis; (2) occurrence of HCC, decompensation, or mortality in patients with cirrhosis; and (3) occurrence of mortality in patients with HCC. HR: Hazard ratio; OBI: Occult hepatitis B virus infection; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; AFP: Alpha-fetoprotein; MELD: Model for end-stage liver disease; SVR: Sustained virologic response; HCV: Hepatitis C virus.

Table 4 Clinical factors associated with development of hepatocellular carcinoma

Variable	HR	P value	Adjusted HR	P value
OBI	0.904 (0.251-3.264)	0.878	0.860 (0.209-3.535)	0.835
Age (per year)	1.016 (0.962-1.073)	0.571
Male sex	1.531 (0.536-4.374)	0.427
AST > 40 IU/L	6.120 (1.351-27.729)	0.019	3.383 (0.664-17.226)	0.142
ALT > 40 IU/L	3.573 (0.976-13.075)	0.054
Creatinine (per unit)	0.051 (0.003-0.892)	0.042	0.075 (0.003-2.200)	0.133
AFP > 20 ng/mL	3.381 (1.129-10.121)	0.029	1.706 (0.512-5.678)	0.384
PT-INR (per unit)	10.081 (1.036-77.802)	0.027
Child-Pugh score	3.065 (1.741-5.399)	< 0.001	2.818 (1.547-5.135)	0.001
(per unit)	3.065 (1.741-5.399)	< 0.001	2.818 (1.547-5.135)	0.001
MELD score	1.057 (0.862-1.296)	0.597
(per unit)	1.057 (0.862-1.296)	0.597
SVR	0.289 (0.064-1.302)	0.106
HCV genotype 1	2.049 (0.644-6.517)	0.224

HR: Hazard ratio; OBI: Occult hepatitis B virus infection; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; AFP: Alpha-fetoprotein; PT-INR: Prothrombin time-international normalized ratio; MELD: Model for end-stage liver disease; SVR: Sustained virologic response; HCV: Hepatitis C virus.

Citation: Cho J, Lee SS, Choi YS, Jeon Y, Chung JW, Baeg JY, Si WK, Jang ES, Kim JW, Jeong SH. Occult hepatitis B virus infection is not associated with disease progression of chronic hepatitis C virus infection. World J Gastroenterol 2016; 22(42): 9427-9436
URL: https://www.wjgnet.com/1007-9327/full/v22/i42/9427.htm
DOI: https://dx.doi.org/10.3748/wjg.v22.i42.9427