Spontaneous viral clearance after 6-21 years of hepatitis B and C viruses coinfection in high HBV endemic area.

Aim: To investigate the clinical and virological course of coinfection by hepatitis B virus (HBV) and hepatitis C virus (HCV) in China.

Methods: We enrolled 40 patients with chronic HBV and HCV coinfection (Group BC), 16 patients with chronic HBV infection (Group B) and 31 patients with chronic HCV infection (Group C). They infected HBV and/or HCV during 1982 to 1989. Sera of all the 87 patients were collected in 1994 and 2002 respectively. We detected biochemical and virologic markers and serum HBV DNA and HCV RNA levels of all the patients. B-type ultrasound detection was performed in some patients.

Results: In Group BC, 67.5 % of the patients cleared HBsAg, and 92.5 % of the patients cleared HBeAg. The clearance rate of HBV DNA was 87.5 %. There was no significant difference of HBV clearance between Group BC and Group B. In Group BC, 85.7 % of males and 47.4 % of females cleared HBV, and males were easier to clear HBV (chi(2)=6.686, P=0.010). Such a tendency was also found in Group B. The clearance rate of HCV RNA in Group BC was 87.5 %, significantly higher than that in Group C (chi(2)=22.963, P<0.001). Less than 40 % of the patients in all groups had elevated liver enzyme values. The highest value of alanine aminotransferase (ALT) was 218 u/L (normal range for ALT is 0-40 u/L). In most patients the ultrasonogram presentations changed mildly.

Conclusion: The clinical manifestations of patients with HBV/HCV coinfection are mild and occult. High clearance rate of HBV and easy to clear HBV in male patients are the characteristics of HBV infection in adults in China. HBV can inhibit HCV replication, but no evidence has been found in our data that HCV suppresses HBV replication.