rss
Gut 2004;53:1494-1498 doi:10.1136/gut.2003.033324
  • Liver

Genotype C hepatitis B virus infection is associated with an increased risk of hepatocellular carcinoma

  1. H L-Y Chan,
  2. A Y Hui,
  3. M L Wong,
  4. A M-L Tse,
  5. L C-T Hung,
  6. V W-S Wong,
  7. J J-Y Sung
  1. Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
  1. Correspondence to:
    Dr H L-Y Chan
    Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30–32 Ngan Shing St, Shatin, Hong Kong, China; hlychancuhk.edu.hk
  • Received 17 March 2004
  • Accepted 21 March 2004

Abstract

Background: Identification of risk factors for the development of hepatocellular carcinoma (HCC) is important for HCC surveillance in chronic hepatitis B virus (HBV) infection. Our aim was to study the independent risk factors and effect of HBV genotypes on HCC development in a prospective longitudinal cohort of chronic hepatitis B patients.

Patients and methods: Chronic hepatitis B patients recruited since 1997 were prospectively followed up for the development of HCC. HCC was diagnosed by a combination of α fetoprotein, imaging, and histology. Liver cirrhosis was defined as ultrasonic features of cirrhosis together with hypersplenism, ascites, varices, and/or encephalopathy.

Results: In total, 426 patients were followed up for 1664 person years; median 225 (range 12–295) weeks. Forty nine (11%) patients had underlying clinical liver cirrhosis. A total of 242 (57%) and 179 (42%) patients had HBV genotypes C and B, respectively. Twenty five patients developed HCC in a median follow up of 121 (range 14–236) weeks. The overall incidence of HCC was 1502 cases per 100 000 person years. On multivariate analysis, clinical liver cirrhosis and HBV genotype C infection were independently associated with HCC development, with an adjusted relative risk of 10.24 (95% confidence interval (CI) 4.39–23.89; p<0.001) and 2.84 (95% CI 1.05–7.72; p = 0.040), respectively. Patient age, sex, hepatitis B e antigen (HBeAg) status, alanine aminotransferase (ALT) levels, and basal core promoter mutations did not predict HCC development. Patients infected with HBV genotype C tended to have persistently positive HBeAg or fluctuating HBeAg status and higher ALT levels during the follow up period.

Conclusion: Genotype C HBV infection is an independent risk factor for HCC development in addition to liver cirrhosis.

Footnotes

    This Article

    1. Abstract
    2. Full text
    3. PDF

    Register for free content

    The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

    Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.