Epidemiology, natural history, and treatment of hepatitis B virus and hepatitis C virus coinfection.

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important global public health problems. Coinfection with HBV and HCV is not uncommon due to the shared route of parenteral transmission. The interaction between HBV and HCV in coinfected individuals is complex, and viral interference has been well described. Patients who are coinfected with HBV and HCV have faster rates of fibrosis progression, more severe liver disease, and are at markedly increased risk of developing hepatocellular carcinoma as compared to those with HBV or HCV monoinfection. Therefore, treatment of HBV-HCV coinfection is important, but it is a challenging and evolving field. Hepatitis A virus (HAV) superinfection is associated with a high risk of liver failure and death in patients with underlying chronic liver disease, and all individuals with HBV-HCV coinfection should receive the HAV vaccine.