Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a substantial proportion of liver diseases worldwide.
Because the two viruses share similar modes of transmission, co-infection with the two viruses is not uncommon, though the vast majority of those coinfected with HCV and HBV acquired these viruses through intravenous drug use, unscreened blood products, or exposure to dirty needles and unsterilized medical equipment
The exact number of patients co-infected with HCV and HBV is unknown and may be underestimated because the hepatitis C virus can become the “dominant” liver virus, and reduces hepatitis B virus levels to be nearly undetectable. In patients with chronic hepatitis B, estimates of the rates of HCV co-infection vary from 9% to 30%. The primary concern with HBV/HCV co-infection is that it can lead to more severe liver disease and an increased risk for progression to liver cancer (HCC).
Treatment of HBV/HCV coinfected patients can represent a challenge. AASLD recommends starting people with HBV/HCV coinfection, who meet the criteria for treatment of active HBV infection, on therapy at the same time or before starting direct acting antiviral (DAA) for HCV treatment. Patients with low or undetectable HBV DNA levels should be monitored at regular intervals during hepatitis C treatments. Those requiring treatment for HBV should be placed on therapy based on AASLD’s HBV treatment guidelines. Those with HCV who have resolved the HBV virus, whether spontaneously resolving the infection or following treatment, should be monitored for HBV reactivation while on DAA therapy.