Which Is Worse, Hepatitis B or Hepatitis C?

Chronic hepatitis B and chronic hepatitis C, while caused by different viruses are clinically indistinguishable. Both affect the liver and both are potentially fatal.  Over years or decades, chronic HBV and HCV infection can progress to severe liver diseases including cirrhosisliver cancer, and ultimately end-stage liver failure.

However, until now, few head-to-head comparisons of clinical outcomes have been attempted.

So, we were really interested to read a new study published in the Journal of Clinical Infectious Diseases.  This study is the first in which the effects of hepatitis B and hepatitis C virus infections were compared in a relatively homogeneous population.

Researchers from Johns Hopkins, led by Oluwaseun Falade-Nwulia, studied almost 7,000 American men included in the large Multicenter AIDS Cohort Study (MACS) prospective database of men who have sex with men.

Approximately 5% of participants entered the study with each type of chronic hepatitis.  At the end of an 8 year follow-up, all-cause mortality was similar in both groups, but liver-related mortality was significantly higher for those with chronic hepatitis B infections. This finding held true for both HIV-negative and HIV-positive participants, including those who were severely immune-compromised.

Excluding the few men in the study who underwent treatment for hepatitis C, infection did not change the pattern. However, liver-related deaths among participants who were co-infected with hepatitis B and HIV and who were enrolled after 2002 were markedly lower than among those who were enrolled earlier, possibly reflecting use of newer antiviral drugs that are active against both HIV and hepatitis B virus.

These results are worth noting for a number of reasons.  First, they underscore the need for expansion of HBV screening and vaccination to protect against HBV infection. Second, they suggest individuals co-infected with HIV/HBV should be treated with dually active drugs.

And lastly, despite the recent surge of public health advertisements that have brought hepatitis C screening and treatment into the public eye, clinicians should remember that hepatitis B is still out there, and that effective oral treatment can save lives.

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