| Summary: | 碩士 === 臺灣大學 === 流行病學研究所 === 95 === Background and Aims: Taiwan is an endemic area of hepatitis B. Dual infection of hepatitis B virus (HBV) and hepatitis C virus (HCV) is not unusual. However, the natural history of dual infection in the population remained unknown. We sought to determine the liver-related morbidity and mortality and the long-term viremia profiles of HBV for dual infection in a population-based longitudinal cohort study.
Materials and Methods: The cohort consisted of 5189 men (2643 HBsAg (+) alone, 176 anti-HCV (+) alone, 161 HBsAg (+) and anti-HCV (+), and 2209 HBsAg (−) and anti-HCV (−)) aged 30 years or older who were enrolled between 1989 and 1992, and followed through December 31, 2005. HBV genotype and DNA levels were measured using polymerase chain reaction-based assays. Plasma HBV DNA levels were assessed for multiple samples consecutively collected from each man with dual infection of HBV and HCV. All statistical tests were two-sided.
Results: The incidence of hepatocellular carcinoma and liver-related mortality (per 100000 persons) were 296.8 and 202.9, 202.0 and 39.9, 221.9 and 176.4, and 12.6 and 9.5, respectively, in those who were positive for HBsAg alone, those who were positive for anti-HCV alone, those who were positive for HBsAg and anti-HCV, and those who were negative for both markers. During follow-up, 35 men with dual infection developed chronic liver disease (i.e., hepatocellular carcinoma, liver cirrhosis, or longitudinal alanine aminotransferase [ALT] elevation defined as abnormality detected in >=50% of the visits), and 6 had hepatic flare (ALT>5×upper limit of the normal levels). Initial viral load was positively associated with the persistence of high viral load (>=10^4.45 copies/mL). High tracking for viral load, as evidenced by the high predictability of initial viral load, was observed within 6 years. Longitudinal high HBV viral load detected in >=50% of the visits (adjusted odds ratio [OR]=2.71, 95% confidence interval [CI]=1.15~6.36) and anti-HCV optical density (adjusted OR=1.25, 95% CI=1.01~1.55) were significantly associated with the development of chronic liver disease. An extremely high viral load (defined as >=10^5.81 copies/mL) (OR=13.36, 95% CI=1.49~120.0) was the only predictor for hepatic flare.
Conclusions: The incidence of HCC and liver-related mortality among men with dual infection were similar to those among men with HBV monoinfection. HBV viral load was fairly stable, as evidenced by long-term persistence of high viral load. Persistently high viral load and anti-HCV optical density were associated with the development of chronic liver disease.
|
|---|
