RESEARCH ARTICLEOpen Access
A retrospective case-control study of hepatitis C
virus infection and oral lichen planus in Japan:
association study with mutations in the core and
NS5A region of hepatitis C virus
Yumiko Nagao1*and Michio Sata1,2
Background: The aims of this study were to assess the prevalence of hepatitis C virus (HCV) infection in Japanese
patients with oral lichen planus and identify the impact of amino acid (aa) substitutions in the HCV core region
and IFN-sensitivity-determining region (ISDR) of nonstructural protein 5A (NS5A) associated with lichen planus.
Methods: In this retrospective study, 59 patients (group 1-A) with oral lichen planus among 226 consecutive patients
who visited our hospital and 85 individuals (group 1-B, controls) with normal oral mucosa were investigated for the
presence of liver disease and HCV infection. Risk factors for the presence of oral lichen planus were assessed by
logistic regression analysis. We compared aa substitutions in the HCV core region (70 and/or 91) and ISDR of NS5A of
12 patients with oral lichen planus (group 2-A) and 7 patients who did not have oral lichen planus (group 2-B)
among patients (high viral loads, genotype 1b) who received interferon (IFN) therapy in group1-A.
Results: The prevalence of anti-HCV and HCV RNA was 67.80% (40/59) and 59.32% (35/59), respectively, in group 1-
A and 31.76% (27/85) and 16.47% (14/85), respectively, in group 1-B. The prevalence of anti-HCV (P < 0.0001) and
HCV RNA (P < 0.0001) in group 1-A was significantly higher than those in group 1-B. According to multivariate
analysis, three factors - positivity for HCV RNA, low albumin level (< 4.0 g/dL), and history of smoking - were
associated with the development of oral lichen planus. The adjusted odds ratios for these three factors were 6.58,
3.53 and 2.58, respectively, and each was statistically significant. No significant differences in viral factors, such as aa
substitutions in the core region and ISDR of NS5A, were detected between the two groups (groups 2-A and -B).
Conclusion: We observed a high prevalence of HCV infection in patients with oral lichen planus. Longstanding
HCV infection, hypoalbuminemia, and smoking were significant risk factors for the presence of oral lichen planus in
patients. It is advisable for Japanese patients with lichen planus to be tested for HCV infection during medical
Hepatitis C virus (HCV) infection is a major public
health problem because it causes chronic hepatitis, cir-
rhosis and hepatocellular carcinoma (HCC). In Japan,
elderly patients are at a higher risk for HCC and hepati-
tis C viral eradication has a smaller effect on hepatocar-
cinogenesis in older patients . In Japan, refractory
cases with genotype 1b and high viral loads are seen in
as many as 70% of chronic hepatitis C patients.
Recent studies have identified both viral and host fac-
tors predictive of the outcome of interferon (IFN) ther-
apy. Among theviral
substitutions in the region amino acids (aa) 2209-2248
(IFN-sensitivity-determining region, ISDR, of nonstruc-
tural protein 5A, NS5A, in HCV genotype 1b) is asso-
ciated with a sustained virological response (SVR) after
IFN treatment of HCV genotype 1b patients [2,3]. In
addition, Akuta et al. reported that aa substitution at
factors, thenumber of
* Correspondence: firstname.lastname@example.org
1Department of Digestive Disease Information & Research, Kurume University
School of Medicine, Kurume, Fukuoka 830-0011, Japan
Full list of author information is available at the end of the article
Nagao and Sata BMC Gastroenterology 2012, 12:31
© 2012 Nagao and Sata; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
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The pre-publication history for this paper can be accessed here:
Cite this article as: Nagao and Sata: A retrospective case-control study
of hepatitis C virus infection and oral lichen planus in Japan:
association study with mutations in the core and NS5A region of
hepatitis C virus. BMC Gastroenterology 2012 12:31.
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