Approach to patients with HBV and HCV coinfection

Coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV) is not uncommon, based on the high prevalence of both infections and their shared routes of transmission. Coinfected patients have higher rates of acute liver failure, decompensated cirrhosis, and hepatocellular carcinoma than do their monoinfected counterparts and therefore present a unique challenge to the clinician. The serology and virology of HBV and HCV in coinfection are dynamic and have many different patterns. Interestingly, both viruses interact such that each virus inhibits the other, usually with one virus being dominant. The dominant virus should generally be the target of antiviral therapeutic intervention. Studies with limited numbers of patients have assessed the success of treatment with standard interferon alone and in conjunction with either ribavirin or lamivudine. Higher doses of interferon appear to be required for the best outcome. Treatment guidelines have not been established for patients coinfected with HBV and HCV; therefore, treatment decisions are often made on an individual basis. The epidemiology, natural history, and current management of patients with HBV and HCV coinfection are the focus of this updated review. Copyright © 2008 by Current Medicine Group LLC.