Anca Streinu-Cercel 1,2, Ileana Rebedea 1,2, Oana Streinu-Cercel 2, A. Streinu-Cercel 1,2, Liliana Preoţescu 1,2, Daniela Manolache 1
1 National Institute for Infectious Diseases „Prof. Dr. Matei Balş” Bucharest, Romania
2 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Faculty of Medicine
Abstract
Hepatitis B virus (HBV) is known to infect over 500 million people worldwide while WHO estimates that there are more than 170 million chronic HCV carriers. A study conducted in 2009 in Romania revealed a seroprevalence of HBV infection of 5.59% and of 4.56% for HCV infection [ASRF, 2009]. HBV and HCV coinfection is one of the leading problematics in the area of infectious diseases. The National Institute for Infectious Diseases „Prof. Dr. Matei Balş”, Bucharest is one of the excellence centers in Eastern Europe for diagnosing and treating hepatitis B and C. During 2009, the National Institute for Infectious Diseases „Prof. Dr. Matei Balş” monitored 3027 patients with chronic HBV hepatitis, out of which 402 patients presented chronic HBV HDV coinfection, 256 patients presented acute HBV hepatitis without comatose state and 3 presented acute HBV hepatitis with comatose state. In 2009, we also monitored 6012 patients with chronic HCV hepatitis and we admitted 26 cases of acute HCV hepatitis and 3 cases of HEV acute hepatitis. Out of the total number of patients monitored in our clinic almost 3% represent HBV and HCV coinfections. This article compares the evolution of 5 cases of HCV superinfection in patients with chronic HBV infection. All of the patients were diagnosed within the National Institute for Infectious Diseases „Prof. Dr. Matei Balş” and 4 out of the 5 cases were treated with specific antiviral therapy. Patients 1 through 4 attained and maintained undetectability for HCV-RNA while patient 5, who refused antiviral treatment, developed a chronic HCV hepatitis with fluctuating viral load values. All patients treated with Peg IFN and ribavirin for HCV hepatitis responded well to therapy, with undetectability of viral load at 2 weeks of treatment. One treated patient positivated the HCV viral load 5 years after the initial HCV hepatitis. We suspect this may be associated with administration of hepato-toxic drugs. We also present an illustrative case report of a patient with a particular evolution under HBV antiviral treatment with lamivudine and successive HCV treatment with Peg IFN and ribavirin, discussing the possible role of the chronology of HBV and HCV infection on the evolution of the hepatic disorder.