Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis

H. Wang, R. Swann, E. Thomas, H. Innes, H. Valerio, P.C. Hayes, S. Allen, S.T. Barclay, D. Wilks, R. Fox, D. Bhattacharyya, N. Kennedy, J. Morris, A. Fraser, A. Stanley, R. Gunson, P. Mcintrye, S. Hutchinson, P.R. Mills, J. Dillon

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Abstract

Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.
Original languageEnglish
Pages (from-to)930-938
Number of pages9
JournalJournal of Viral Hepatitis
Volume25
Issue number8
Early online date25 Mar 2018
DOIs
Publication statusPublished - Aug 2018

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Chronic Hepatitis C
Hepatitis B
Hepatitis B virus
Virus Diseases
Hepacivirus
Infection
Population
Liver
Surface Antigens
Hepatocellular Carcinoma
Fibrosis
Hepatitis B Core Antigens
Information Services
Mortality
Health
Scotland
Survival Analysis
Hepatitis C
Hepatitis B Surface Antigens
Coinfection

Keywords

  • cirrhosis; decompensation; hepatitis B core antigen; hepatocellular carcinoma; vaccination; viral hepatitis

Cite this

Wang, H. ; Swann, R. ; Thomas, E. ; Innes, H. ; Valerio, H. ; Hayes, P.C. ; Allen, S. ; Barclay, S.T. ; Wilks, D. ; Fox, R. ; Bhattacharyya, D. ; Kennedy, N. ; Morris, J. ; Fraser, A. ; Stanley, A. ; Gunson, R. ; Mcintrye, P. ; Hutchinson, S. ; Mills, P.R. ; Dillon, J. / Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis. In: Journal of Viral Hepatitis. 2018 ; Vol. 25, No. 8. pp. 930-938.
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abstract = "Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95{\%} CI: 1.01-1.65) and HCC (HR: 1.64, 95{\%} CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95{\%} CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.",
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author = "H. Wang and R. Swann and E. Thomas and H. Innes and H. Valerio and P.C. Hayes and S. Allen and S.T. Barclay and D. Wilks and R. Fox and D. Bhattacharyya and N. Kennedy and J. Morris and A. Fraser and A. Stanley and R. Gunson and P. Mcintrye and S. Hutchinson and P.R. Mills and J. Dillon",
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Wang, H, Swann, R, Thomas, E, Innes, H, Valerio, H, Hayes, PC, Allen, S, Barclay, ST, Wilks, D, Fox, R, Bhattacharyya, D, Kennedy, N, Morris, J, Fraser, A, Stanley, A, Gunson, R, Mcintrye, P, Hutchinson, S, Mills, PR & Dillon, J 2018, 'Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis', Journal of Viral Hepatitis, vol. 25, no. 8, pp. 930-938. https://doi.org/10.1111/jvh.12897

Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis. / Wang, H.; Swann, R.; Thomas, E.; Innes, H.; Valerio, H.; Hayes, P.C. ; Allen, S.; Barclay, S.T.; Wilks, D.; Fox, R.; Bhattacharyya, D.; Kennedy, N.; Morris, J.; Fraser, A.; Stanley, A.; Gunson, R.; Mcintrye, P.; Hutchinson, S.; Mills, P.R.; Dillon, J.

In: Journal of Viral Hepatitis, Vol. 25, No. 8, 08.2018, p. 930-938.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis

AU - Wang, H.

AU - Swann, R.

AU - Thomas, E.

AU - Innes, H.

AU - Valerio, H.

AU - Hayes, P.C.

AU - Allen, S.

AU - Barclay, S.T.

AU - Wilks, D.

AU - Fox, R.

AU - Bhattacharyya, D.

AU - Kennedy, N.

AU - Morris, J.

AU - Fraser, A.

AU - Stanley, A.

AU - Gunson, R.

AU - Mcintrye, P.

AU - Hutchinson, S.

AU - Mills, P.R.

AU - Dillon, J.

N1 - Acceptance from webpage AAM: 12m embargo

PY - 2018/8

Y1 - 2018/8

N2 - Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.

AB - Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver-related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause-specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01-1.65) and HCC (HR: 1.64, 95% CI: 1.09-2.49), but not liver-related death (HR: 1.02, 95% CI: 0.80-1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy.

KW - cirrhosis; decompensation; hepatitis B core antigen; hepatocellular carcinoma; vaccination; viral hepatitis

U2 - 10.1111/jvh.12897

DO - 10.1111/jvh.12897

M3 - Article

VL - 25

SP - 930

EP - 938

JO - Journal of Viral Hepatitis

JF - Journal of Viral Hepatitis

SN - 1352-0504

IS - 8

ER -