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Editor,—Dr Marusawa and colleagues (OpenUrlAbstract/FREE Full Text) , commenting on their findings of a high prevalence of antibodies to hepatitis B virus (HBV) core antigen (anti-HBc) in Japanese patients with hepatitis C virus (HCV) chronic liver disease, suggest that HBV infection has a role in the development of hepatocellular carcinoma (HCC) in patients with chronic HCV infection. I would like to raise a methodological point that may influence the interpretation of their findings.
HBV and HCV infections share common mechanisms of transmission and are highly correlated. Therefore, it is not surprising that the prevalence of anti-HBc was much higher in individuals with chronic HCV infection than in the anti-HCV negative controls. But why would patients with HCV associated HCC have a higher prevalence of anti-HBc than individuals with HCV chronic hepatitis and liver cirrhosis? Stratified analyses suggested this finding is not related to age or …