Previous hepatitis B virus infection and the risk of liver-related complications in patients after HCV cure – Data on more than 6000 patients from the German Hepatitis C-Registry (DHC-R)

Background: Previous exposure to hepatitis B virus (HBV) is often unrecognized and may influence the risk of developing hepatocellular carcinoma (HCC) and other liver-related events (LRE) in particular in patients after HCV cure. Previous studies are not conclusive and there are only few large studies from Europe.

Methods: We analyzed clinical endpoints (≥3-point increase in MELD score, esophageal variceal bleeding, ascites, encephalopathy, liver transplantation, death, with/without HCC; HCC alone) in patients cured from HCV. Data were obtained from the German Hepatitis C Registry. Patients after organ transplantation, a history of HCC, or HIV co-infection were excluded. Statistical analyses included Kaplan-Meier curves to analyze the influence of HBV serological markers and logistic regression to identify predictors of clinical endpoints.

Results: A cohort of 6,355 patients fulfilled inclusion criteria, the median time of follow-up was 2.5 years (range 0.04 – 8.01). Serological evidence of previous HBV exposure was present in 1,889 patients (HBsAg negative/anti-HBc positive) while 157 patients had active hepatitis B (HBsAg positive). Univariate analysis identified age 50-70 years (odds ratio [OR], 2.04), sex (OR, 1.38), cirrhosis (OR, 4.88), anti-HBc-positivity (OR, 1.49) and diabetes mellitus (OR, 2.71) as risk factors for LRE. Multivariate analysis confirmed male sex, older age, cirrhosis and diabetes as independent risk factors.

Conclusions: The clinical impact of previous HBV in HCV patients after SVR requires further investigation. We suggest that occult HBV infection should be considered a contributing factor for potential adverse disease outcomes also in Caucasian patients.

Publication History

Article published online:
20 January 2025