HBV HCV Co-Infection: A Dual Threat

Abstract

Background: The global HBV-HCV co-infection prevalence is estimated between 3%-30%. Such co-infected patients have a severe liver disease & and higher chances of hepatocellular carcinoma compared to mono infections. Moreover, many patients with Hepatitis B or Hepatitis C are incidentally diagnosed thus making it difficult to gauge the actual prevalence of the infection. Adding to the woes is the fact that screening hepatitis B only with Hbs Ag will underdiagnose many HBV-HCV co infected patients. It is widely believed that HCV is dominant over HBV. However, HBV can be the dominating virus in co-infections as observed in our case report.

Case Presentation: Two middle-aged patients having chronic kidney disease and on dialysis with a past history of surgery and blood transfusion were diagnosed incidentally with HBV HCV co-infection. None of them had taken any treatment for either viruses prior to this. One case showed a dominance of HBV while other showed the dominance of HCV. Both patients had HCV Genotype 1a while HBV genotyping could not be done. Both patients died within 6 months of diagnosis.

Conclusion: Screening must be ensured for both HBV & HCV in patients with common risk factors. Either HCV or HBV can be the dominant virus in case of a co-infection. Patients with HCV as the dominant virus may have a higher APRI and FIB-4 score.