ABSTRACT
Concurrent infections with hepatitis B virus [HBV] and hepatitis C virus [HCV] are increasingly recognized in patients with both acute and chronic hepatitis and the reciprocal influence of dual infection remains controversial. In Egypt, the last decade showed a remarkable decline in HBV infection associated with remarkable rise in HCV infection. This study investigates the prevalence of occult HBV in adults with HCV related chronic liver disease [CLD] to spot lights on its importance on the clinical outcomes. Ninety five patients with HCV related chronic liver disease [median age 50 yrs] were enrolled in this study. Thirty of them were suffering from hepatocellular carcinoma [HCC]. Sera were tested for HCV antibodies, HCV-RNA [nested RT-PCR], HBV markers [HBsAg, Anti-HBcAb IgM and total, HBeAg] and HBV-DNA [nested PCR for s, c and x regions]. All the studied patients were anti-HCV positive, where 47/95 [49.5%] of them were HCV RNA positive. HBsAg was detected in 25/95 [26.3%] [Overt HBV infection], Total anti-HBc was detected in 52/83 [62.65%], HBV-DNA was positive among 41/95[43.1%] with greatest prevalence for "c" region 39/95 [41%]. HBV DNA positive / HBsAg negative [occult HBV infection] was significantly prevalent in HCV-CLD vs HCC patients[p<0.001], and was found to be significantly increased in those who were HCV RNA positive rather than in HCV RNA negative patients [P< 0.05]. No significant difference was detected between patients with occult or over HBV infection as regard to liver enzymes or Child classification [P>0.05]. Occult HBV infection was found to be significantly increased in HCV related chronic liver disease with [p<0.05]. The high prevalence occult HBV-infection [particularly core DNA] may have clinical implications in the pathogenesis and therapy of HCV induced chronic liver disease. Standardized definition and diagnostic criterion of occult HBV infection are needed for future research to determine its prevalence and clinical significance