Jpn. J. Infect. Dis., 52, 1999

Laboratory and Epidemiology Communications

Apparent Cure of Hepatitis C Virus Carrier State afterHepatitis B Virus Superinfection
Shuya Yoshinaga*, Sugano Fukushima, Naohiko Masaki and Shigeki Hayashi
Division of Gastroenterology, International Medical Center of Japan,Toyama 1 ‑21 ‑1, Shinjuku‑ku, Tokyo

Communicated by Hiroshi Yoshikura(Accepted November 22, 1999)

Hepatitis C virus(HCV) is known to interfere with infec‑
tion by the hepatitis B virus (HBV)(1,2). This may accountfor the rarlty Of superinfection of HCV carriers by HBV incarrier was superinfected by苛HBV between September andOctober 1997. The liver biopsy indicated CH, A2, and Fl●resrx)nds well to inferferon (IFN) treatment, though the response(activity grade 2/4, fibrosis grade 1/4)･ Interestingly, HCV
RNA level had decreased to an undetectable level (<l x 103
copies/mJ) in December 1997.

depends upon the HCV genotype; type 2 HCV responds wellto IFN, type 1 responds poorly.

continued to be positive. IFN therapy was started on Februarycomparison with the oppositetype of superinfection. HCVAfter admission, the AIJ level remained highand HBeAg

We recently encountered an interesting case of a type lb27, 1998. IFN α at a dose of 9,000,000 U was administered

HCV carrier who was superinfected by HBV. After thesuperinfection, HCV apparently disappeared and IFN treat‑

daily. Due to elevated All value (438 IU/I) attributable toment apparently cured both hepatitis viruses.

to three Injections a week. The AIJ level gradually attained
the normallevel, and HBV DNAand HBeAg tuame undetect‑able. The IFN therapy was terminated in August 1998, andsince that time (13 months prior to the time of this report) thenormal All level and the undetectable level of HBV DNAand HCV RNA have been maintained.
Reports on HBV superinfection in HCV carriers are scarcethough not totally unheard of (3). In most of such cases, HCV
level decreased after HBV superinfection.

IFN,the daily dose was reduced to 6,(X札∝X) U andthefrequency●A 45‑year‑old male patient came to our outpatient department
for ex.amination of HCV in May 1997 (Fig･)I He was asyヮp‑tomatlC･ The genotypeof HCV was type lb and the vlruStiter was l･1× 106 copies/mJ･ HBsAg was negative･ He had

no transfusion history. In November 1997, transaminase(AIJ) increased suddenly.
In February 1998, he was admitted to our hospital for

examination and therapy. AIJ was 222 IU/1. He was found●Usually viral interference is exerted on the superinfecting

positive fわr HBV HBsAg was 20,480× ; anti‑HBs, 0.0 mIU/ml; HBeAg, 421.1 (S/N); anti‑HBe, 0.0%; anti‑HBc, 88.4%;
IgM HBc antibody, 0.4; and core of index and HBV DNA,I,575 pg/ml. Anti‑HCV was >50 cut‑off (Col) index. HCVRNA (Amplicor) was Pegative･virus by the virus that established infection earlier･ The relation

His sera were examlned retrospectively; it was found thatin the ordinary sense. This suppression may have been a

his semm, negative fわr HBsAg in September 1997, had tuned

local reaction induced by HBV in the liver, which actively

positive in October; IgM HBc antibody turned positive interminated the replication of HCV･ Local production of IFN

December 1997. Therefわre, it was concluded that this HCV

or other cytokines is a cu汀ent Candidate for such a reaction･

is inverted here. The superinfecting virus HBV suppressed
the persistence of HCV Therefわre, the suppression of HCV

by HBV superinfection may not be due to viral interference

Intrahepatic administration of IFN or HBV antigen could beALTHCV RNA(kc/ml)(tU/ml) lgMHBc‑+HBV

considered for therapy of HCV resistant to IFN･DNA(p9/mJ)

REFERENCES

l. Brotman, B., Prince, A. M., Huima, T., Richardson, L.,van den Ende, M. C. and fVeifer, U. (1983): Interference
between non‑A, non‑B and hepatitis B virus infection inchimpanzees. ∫. Mらd. Virol･, 1 1, 191‑205･

2. Liaw,Y F (1995): Role of hepatitis C virus in dual andtriple hepatitis virus infection･ Hepatology, 22, 1 101‑

■ヽ一0 01108.
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トN＼N＼∞66LJの＼∞6 8]寸＼∞6NN＼SJ∞66LJ9]86

トLJLJ∞6LN＼eJ∞63. WletZke, P., Schott, P., Braun, F., Mihm, S. and Ramadori,

NN＼OLJ66

G. (1999): Cleannce of HCV RNA in a chronic hepatitis
C virus‑infected patient during acute hepatitis B virus
superinfection･ Liver, 19, 348‑353･
Figure･ ClimiCalcourse･*Corresponding author: Fax: +81‑3‑3232‑0965

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