Sustained HCV-RNA response and HBs-seroconversion after individualized antiviral therapy with pegylated interferon alpha plus ribavirin and active vaccination in an HCV/HBV-coinfected patient

Hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection is frequently associated with progressive liver disease. Treatment options are limited and no data on the efficacy of pegylated interferon plus ribavirin therapy are available.

We report a case of a 49-year old woman with chronic hepatitis B and C who was scheduled for a 48 weeks course of pegylated interferon alpha-2b plus ribavirin therapy. She had HCV genotype 2 infection and was negative for HBV-DNA and HBeAg before treatment. While the HCV-RNA response was rapid until week 12, HBsAg levels showed a more linear decline. At week 48, HBsAg was still positive, however, with very low levels of only 0.06 IU/ml. Treatment was therefore continued for another 4 weeks combined with active HBV immunization until HBs seroconversion occurred. Forty-three weeks after treatment, the patient showed a robust HBs-seroconversion (anti-HBs of 260 IU/mL) and a sustained HCV-RNA response.

This case highlights that combination therapy of PEG-IFN-a2b with ribavirin of HBV/HCV-coinfected individuals can not only induce a sustained HCV-RNA response but also HBsAg seroconversion in single patients. Monitoring of HBsAg levels can be useful in individualizing optimal treatment duration in HBV-infected patients.