Which is Worse, Hepatitis B or Hepatitis C?

hep.bChronic hepatitis B infection was associated with higher liver-related mortality.

Chronic hepatitis B and chronic hepatitis C virus infections are both potentially fatal conditions, but few head-to-head comparisons of clinical outcomes have been attempted.

Among almost 7000 American men included in a large prospective database of men who have sex with men, about 5% of participants entered the study with each type of chronic hepatitis. After a median follow-up of almost 8 years, 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 immunocompromised.

Excluding the few men in the study who underwent treatment for hepatitis C infection did not change the pattern. However, liver-related mortality among participants who were coinfected with hepatitis B and HIV and who were enrolled after 2002 was 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.

Comment: This study is the first in which the effects of hepatitis B and hepatitis C virus infections were compared in a relatively homogeneous population. Its results are worth noting because a surge of public health advertisements have brought hepatitis C screening and treatment into the public eye recently. Clinicians should remember that, despite vaccination, hepatitis B is still out there, and effective oral treatment can save lives.

— Abigail Zuger, MD                                                     

Published in Journal Watch General Medicine September 20, 2012

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