Brief Article
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World J Hepatol. Oct 27, 2013; 5(10): 577-583
Published online Oct 27, 2013. doi: 10.4254/wjh.v5.i10.577
Primary biliary cirrhosis in HBV and HCV patients: Clinical characteristics and outcome
Eirini I Rigopoulou, Kalliopi Zachou, Nikolaos K Gatselis, Georgia Papadamou, George K Koukoulis, George N Dalekos
Eirini I Rigopoulou, Kalliopi Zachou, Nikolaos K Gatselis, Georgia Papadamou, Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, 41110 Larissa, Greece
George K Koukoulis, Department of Pathology, Medical School, University of Thessaly, 41110 Larissa, Greece
George N Dalekos, Department of Medicine and Research Laboratory of Internal Medicine, Medical School, University of Thessaly, 41110 Larissa, Greece
Author contributions: Rigopoulou EI, Zachou K and Dalekos GN had the original idea for the study, designed the study protocol and wrote the paper; Zachou K and Gatselis NK did the immune serology and virologic work-up and along with Rigopoulou EI; Papadamou G and Dalekos GN assessed the patients from the immunological and virological points of view; Koukoulis GK did the interpretation of the histological data of the patients; Zachou K, Gatselis NK and Dalekos GN collected the whole data, treated the patients in collaboration with Rigopoulou EI and Papadamou G, and performed the follow-up assessment while contributed to the final version of the paper; Koukoulis GK and Dalekos GN wrote the final version of the paper; all authors have seen and approved the final draft of the paper.
Supported by the Research Committee of the University of Thessaly in part (Code No. 2466)
Correspondence to: George N Dalekos, MD, PhD, Professor, Head, Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Biopolis, 41110 Larissa, Greece. dalekos@med.uth.gr
Telephone: +30-241-3502285 Fax: +30-241-3501557
Received: August 1, 2013
Revised: September 13, 2013
Accepted: October 16, 2013
Published online: October 27, 2013
Processing time: 85 Days and 4.4 Hours
Abstract

AIM: To present the characteristics, management and outcome of patients with hepatitis B virus (HBV) or hepatitis C virus (HCV) infections concurrent with primary biliary cirrhosis (PBC).

METHODS: Since January 2001 to September 2009, we retrospectively evaluated the medical records of all HBV (n = 1493) and HCV patients (n = 526) who are followed in our center for the presence of concurrent PBC. Seventeen patients identified with concurrent viral hepatitis and PBC (8 HCV and PBC; follow-up: 61 ± 37 mo and 9 HBV and PBC; follow-up: 57 ± 38 mo). PBC diagnosis was established if the patients met at least two of the following criteria: positivity for antimitochondrial antibody, elevated cholestatic enzymes and histological lesions of PBC.

RESULTS: HCV or HBV diagnosis preceded that of PBC in most patients by many years. PBC diagnosis was based on the presence of antimitochondrial antibody and elevated cholestatic enzymes in all 17 patients, while one third (5/17; 29.4%) experienced severe pruritus many years before diagnosis. Patients with PBC and HBV were significantly younger at diagnosis of PBC compared to patients with PBC and HCV (56.1 ± 11.2 vs 68.5 ± 10.3, respectively, P < 0.05). At initial clinical and histological assessment the majority of patients were cirrhotics (10/17; 58.8%) with the group of PBC and HCV carrying the highest frequency (87.5% vs 33.3% in PBC and HBV; P < 0.05). The patients with HBV and concomitant PBC seem to have better outcome compared to those with HCV and PBC since none of the 6 non-cirrhotics with HBV and PBC developed cirrhosis during follow-up.

CONCLUSION: PBC diagnosis in HBV or HCV patients is very difficult and usually delayed. Therefore, in any case, cholestasis should alert physicians to further search for PBC.

Keywords: Antimitochindrial antibodies, Autoimmune liver disease, Hepatitis B virus, Hepatitis C virus, Primary biliary cirrhosis.

Core tip: In hepatitis B virus (HBV) and hepatitis C virus (HCV) patients the possibility of concomitant primary biliary cirrhosis (PBC), is often very difficult to recognize and therefore, a significant delay in PBC diagnosis in this specific group of patients is usual. In this report, we clearly show that almost 1% of our HBV and HCV cohort had also PBC which had been misdiagnosed or underestimated for many years. The latter could be the reason of unfavorable outcome observed in our patients and in particular, among HCV/PBC patients. Therefore, the existence of cholestasis should prompt physicians to sick for antimitochondrial antibody with various sensitive techniques irrespective of the presence of other liver diseases.