Differential Viral Load of HBV and HCV in Co-infected Patients: A Potential Battle between the Viruses

Abstract

Viral hepatitis is one of the major health problems in which Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) have the highest affinity to cause chronic liver disease. 5% of the people are infected from HBV and 1% are infected from HCV worldwide. In Pakistan 7.4% of the population is suffering with HBV and HCV (An Overview of Hepatitis B and C in Pakistan). Chronic infection of HBV and HCV leads to slow progressive liver diseases. In a period of 30 years or more, infection can lead to liver cirrhosis, chronic liver failure and hepatocellular carcinoma. Co-infection is more frequent than single infection particularly in areas where these two viruses are endemic. To observe and compare the viral loads of HBV and HCV in co-infected and mono infected patients in Karachi, Pakistan. A total 419 serum samples were collected from suspected patients with HBV and HCV infection. 276 were males and 143 were females, with the age ranging from 10 to 40 years. HBV DNA and HCV RNA were extracted and amplified by Abbott sp2000 and Abbott rt2000 respectively as per the manufacturing protocol. 419 serum samples were screened for HBV and HCV viral load by real time PCR. 276 (66%) were male and 143 (34%) were female. HBV viral load was detected in 157 patients (37.4%), HCV viral load was detected in 86 patients (20%), whereas HBV/HCV Co-infected patients were detected in 89 (21%) patients. In co-infected patients, an HCV viral load of 1000 was 52 (58%) patients. The HBV viral load of 1000 was in 57 (64.04%). 87 (20.76%) of the patients tested negative for both HBV and HCV. Pakistan is a developing country with limited economic and health care resources, low literacy rates and limited awareness about diseases. As HBV and HCV share the same routes of transmission, the chances of co-infection of HBV and HCV are increased. The incidence of co-infection also increases the chances of cancer possibly due to the combined oncogenic action of both viruses. Co-infected patients ranging from 10-40 years old showed that the incidence of infection is higher in younger males as compared to females. This may correlate with more exposure to high risk factors. The HBV viral load was higher than HCV viral load in co-infected patients, indicating that there may be a competition between the two viruses in which HCV is suppressed by HBV.