Primary biliary cirrhosis in HBV and HCV patients: Clinical characteristics and outcome

Table 1 Demographic, clinical, laboratory and histological characteristics of hepatitis C or hepatitis B virus patients with concurrent primary biliary cirrhosis or without primary biliary cirrhosis

	PBC+HCV (n = 8)	PBC+HBV (n = 9)	P value2	HCV (n = 98)	HBV (n = 303)
Sex (male/female)	3/5	2/7	NS	62/36	183/120
Age at diagnosis of viral infection (yr)	59.8 ± 13.9	49.9 ± 13.7	NS	44 ± 17	44.4±15.6
Age at diagnosis of primary biliary cirrhosis (yr)	68.5 ± 10.3	56.1 ± 11.2	< 0.05	NA	NA
Age at last follow up (yr)	71 ± 10	60 ± 12	< 0.10	50 ± 12	53 ± 18.3
Diagnosis of viral hepatitis before primary biliary cirrhosis (no/yes)	0/8	2/7	NS	NA	NA
Interval between diagnosis of viral and primary biliary cirrhosis (mo)3	106 ± 90	106 ± 89	NS	NA	NA
Source of viral infection	6 unknown, 1 transfusion, 1 i.v. drug use	5 unknown, 2 transfusion, 2 vertical	NS	33 unknown, 22 drug abuse, 32 transfusion, 4 multiple hospitalizations, 3 multiple partners, 1 occupational exposure	9 unknown, 46 sexual, 9 transfusion, 103 vertical, 98 intrafamilial, 38 folk remedies
Active viral infection at diagnosis (no/yes)	0/8	5/4	NS	0/98	187/116
HCV genotype (13 patients with HCV infection)	1b in 3, 3 in 1, undefined in 4	NA	NA	1a/1b in 50, 2a/c in 6, 3a in 27, 4 in 9, 6 undefined	NA
Histology at initial diagnosis (no/yes)	3/5 (4 cirrhosis, 1 moderate fibrosis)	2/7 (1 cirrhosis, 1 pre-cirrhotic, 5 mild fibrosis)	NS	25/73 (18 cirrhosis, 53 mild/ moderate fibrosis, 2 severe fibrosis)	202/101 (23 cirrhosis, 78 mild or moderate fibrosis)
Clinically and/or histologically established cirrhosis at initial diagnosis (no /yes)	1/7	6/3	< 0.05	80/18	265/38
Development of cirrhosis during follow up in non-cirrhotic patients (no/yes/NA)	0/1/7	6/0/3	NA	78/2	260/5
Antiviral treatment (no/yes)	4/4	3/6 (2 pre-emptive due to immunosup-pression)	NS	0/98	187/116
Type of antiviral treatment	Peg-IFNa plus ribavirin	Nucleos(t)ide analogues	NA	67 IFNa or Peg-IFNa plus ribavirin, 31 IFNa or Peg-IFNa monotherapy	50 IFNa or Peg-IFNa, 56 Nucleos(t)ide analogues
Response to antiviral treatment (no/yes/NA)	2/2/4	0/6/3	NA	39/59/0	45/71/0
Treatment of primary biliary cirrhosis (no/yes)	2/6	5/4	NS	NA	NA
Duration of therapy (mo)	35.8 ± 24.3	73 ± 68	NS	NA	NA
Type of therapy	UDCA	UDCA1	NA	NA	NA
Response to therapy at last follow up (no/yes/NA)	(2/4/2)	(2/2/5)	NA	NA	NA
Total follow-up (mo)	61 ± 37	57 ± 38	NS	51 ± 28	75 ± 23
Liver related death (no/yes)	6/2	8/1	NS	98/0	279/24

Results are expressed as mean ± SD, unless otherwise stated.

¹One of them received during the course of the disease also budenofalk and later combination of prednisolone with methotrexate due to concomitant CREST syndrome and cryoglobulinemia;

²Means comparison between primary biliary cirrhosis (PBC) + hepatitis C virus (HCV) and PBC + hepatitis B virus (HBV) groups since comparisons between HCV with (n = 8) and without PBC (n = 98) as well as between HBV with (n = 9) and without PBC (n = 303) are not appropriate;

³Interval between diagnosis of viral and primary biliary cirrhosis was estimated in 15/17 patients, in whom the diagnosis of viral preceded that of autoimmune liver disease (excluded are 2 patients with PBC and HBV infection). NA: Not applicable; NS: Not significant; IFN: interferon; UDCA: Ursodeoxycholic acid (dose: 15 mg/kg per day in two divided doses).

Table 2 Laboratory values at initial and last follow up in the individual groups of patients with viral hepatitis and primary biliary cirrhosis (mean ± SD)

Laboratory tests	PBC + HCV(n = 8)	PBC + HBV(n = 9)
Bilirubin initial (mg/dL)	1.0 ± 0.4	1.8 ± 1.7
Bilirubin last	4.3 ± 6.8	2.8 ± 5.8
Albumin initial(gr/dL)	3.8 ± 1.0	4.2 ± 0.7
Albumin last	3.5 ± 0.8	4.1 ± 0.7
PT initial (s)	14.5 ± 4.1	13.6 ± 1.8
PT last	14.8 ± 5.2	12.3 ± 1.4
ALT initial (IU/L)	88 ± 91	82 ± 131
ALT last	48 ± 37	27 ± 12
AST initial (IU/L)	74 ± 64	77 ± 98
AST last	53 ± 29	42 ± 38
γ GT initial (IU/L)	92 ± 139	76 ± 95
γ GT last	47 ± 49	29 ± 16
ALP initial (IU/L)	100 ± 29	106 ± 90
ALP last	93 ± 35	90 ± 33
IgG initial (mg/dL)	1764 ± 470	1815 ± 762
IgG last	2133 ± 612	1420 ± 392
IgM initial (mg/dL)	161 ± 69	281 ± 312
IgM last	264 ± 334	251 ± 186

PBC: Primary biliary cirrhosis; PT: Prothrombine time; ALT: Alanine amonitransferase; AST: Aspartate aminotransferase; γ-GT: Gamma-glutamyl-transpeptidase; ALP: Alkaline phosphatase; HBV: Hepatitis B virus; HCV: Hepatitis C virus.