Chronic hepatitis C increased the mortality rates of patients with hepatocellular carcinoma and diabetes mellitus in a triple hepatitis virus endemic community.
ABSTRACT To elucidate the factors associated with mortality rates among older subjects with hepatocellular carcinoma (HCC) and diabetes mellitus (DM) in a triple hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV) endemic community.
A total of 2,909 residents aged>or=45 years were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and alanine aminotransaminase (ALT) in 1997. Anti-HDV was detected in HBsAg-positive subjects. Those who expired from HCC and DM were identified from official mortality data sets (1997-2003). Survival was analyzed using the Kaplan-Meier survival curve with log-rank test and the Cox proportional hazard model.
Forty-one patients died of HCC and 25 of DM during the study period. Multivariate analysis indicated that age>or=65 years (hazard ratio 3.4; 95% confidence interval 1.8-6.4), HBsAg (3.3; 1.7-6.7), anti-HCV (3.8; 1.7-8.5) and ALT>or=40 IU/L (3.7; 1.9-7.0) were independent predictors of HCC mortality, while age>or=65 years (4.8; 2.1-11.0) and anti-HCV (4.2; 1.7-10.6) were two independent predictors of DM mortality. There were synergistic effects of dual viral infections for HCC, but not for DM mortality.
Old age and chronic HCV infection increase the risk of HCC and DM mortality. HBsAg and ALT levels are also risk factors for HCC mortality, but not DM. The synergistic effects of dual hepatitis viral infections are demonstrable and warrant further investigation.
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ABSTRACT: This study was to elucidate longitudinally quantitative changes of hepatitis B virus (HBV) surface antigen (HBsAg) and HBV DNA in elder HBsAg carriers in a community. Among 1002 residents screened for HBsAg in 2005, 405 responded to this follow-up study in 2010. Fifty-nine (14.6%) were HBsAg carriers in 2005; HBsAg quantification and HBV DNA were measured. HBsAg quantification (cutoff 1600 IU/mL) and HBV DNA (cutoff 2000 IU/mL) were combined to stratify the participants between two screens. A total of 30 men and 29 women with a mean age of 63.9 ± 7.9 years were enrolled. Quantitative levels of HBsAg and HBV DNA were significantly correlated in 2005 (r = 0.509, p < 0.001) and 2010 (r = 0.777, p < 0.001). Concentrations of HBsAg (IU/mL) significantly decreased from 2.2 ± 1.0 log in 2005 to 1.7 ± 1.5 log in 2010 (p < 0.001). The level of HBsAg was decreased in 48 (81.4%) individuals and HBsAg was undetectable in eight (13.6%). The annual incidence of HBsAg clearance was 2.7%. These 59 HBsAg carriers in 2005 were divided into four groups: low HBsAg low HBV DNA (n = 32), high HBsAg low HBV DNA (n = 5), low HBsAg high HBV DNA (n = 12) and high HBsAg high HBV DNA (n = 10). All 32 individuals in the low HBsAg low HBV DNA group were still in that group in 2010, whereas only two of the high HBsAg high HBV DNA group became inactive. As with a younger cohort in hospital, HBsAg quantification was still well correlated with HBV DNA in elderly HBsAg carriers in the community. Lower levels of both HBsAg and HBV DNA might represent an inactive HBV infection. Copyright © 2014. Published by Elsevier Taiwan.The Kaohsiung journal of medical sciences 02/2015; 31(2):102-7. DOI:10.1016/j.kjms.2014.11.002 · 0.81 Impact Factor
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ABSTRACT: Background: Risk factors associated with HCC are well documented, but the synergism between these risk factors are not well examined. The aim of this study was to detect the effect of synergism of two or more risk factors on the development of HCC. Patients & methods: This is a retrospective study of the risk factors of HCC in 300 patients with HCC and 50 patients with chronic liver diseases without HCC as controls. All patients were interviewed about smoking, drinking and family history of HCC. They underwent laboratory investigations (HCVAb, HBsAg, Alpha-fetoprotein and HCV PCR), abdominal ultrasonography and Triphasic CT. Results: Prevalence rate of DM and smoking was significantly higher in HCC cases (59.3% and 69% respectively) than controls (38% and 50% respectively)(P=0.005 and 0.006 respectively). The prevalence of HBsAg and HCVAb was significantly higher in HCC cases (18% and 70% respectively) than controls (4% and 40% respectively)( P =0.02 and 0.0001 respectively). On multivariate analysis, the risk of HCC development in smokers with HBV or HCV was 4.90 and 8.47 respectively (OR) (P =0.0001). It was higher than in non-smokers with HBV or HCV (OR=2.48 and 4.44 respectively)( P =0.037 and 0.0001 respectively) and in smokers without HBV or HCV (OR=2.56 and 2.77 respectively) (P =0.01). The risk of HCC development in HBV or HCV positive patients with DM was 3.98 and 9.19 respectively (OR) (P =0.001 and 0.0001 respectively). It was higher than for HBV or HCV positive patients without DM (OR=2.80 and 4.65 respectively)( P =0.031 and 0.0001 respectively) and that for HBV or HCV negative patients with DM (OR=2.56 and 2.23 respectively)( P =0.011and 0.0001 respectively).Conclusion, HCV and HBV infections, diabetes and smoking are the main determinants of HCC development in Egypt. There is a synergistic effect of many risk factors. An active surveillance and secondary prevention programs for patients with chronic hepatitis are the most important steps to reduce the risk of HCC.American Journal of Science 04/2013; 9(4):211-217. · 3.93 Impact Factor
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ABSTRACT: HBsAg and anti-hepatitis C virus (anti-HCV) are stable markers and widely used. The seroconversion and seroclearance of HBsAg and anti-HCV are important for disease control and prognosis of diseases. To investigate acquirement and disappearance of HBsAg and anti-HCV in an endemic area. Seven years after a community screening, 1002 of 2909 residents of Tzukuan Township were recruited. HBsAg, anti-HCV and alanine transaminase (ALT) were checked in all who participated and hepatitis B virus (HBV) DNA, anti-HBs, anti-HBc, HCV RNA, anti-HDV and upper abdominal ultrasonography were studied in different groups. There were 461 male and 541 female residents with a mean age of 66.7 ± 8.6 years. No new HBsAg carrier was noted and the HBsAg clearance rate was 1.58% per year. One of the 17 cases with HBsAg clearance had positive HBV DNA, three had ALT elevation, two had cirrhosis and seven had anti-HBs seroconversion. Quantitative of HBsAg and HBV DNA were concordant and 78.1% subjects had low levels of titration. Anti-HBc alone contributed to 32.1% and was prominent in old age and the anti-HCV-positive group. The anti-HCV seroconversion rate was only 0.74% per year and household transmission was the only risk factor. Only 37.5% of cases with anti-HCV seroconversion had HCV viraemia and the anti-HCV seroreversion rate was 0.63% per year. The anti-HDV seroconversion rate was 0.72% per year and no subject showed anti-HDV clearance. Much higher rates of HBsAg seroclearance, anti-HCV seroreversion and anti-HBc alone were noted in this endemic area and no subject showed anti-HDV clearance.Liver international: official journal of the International Association for the Study of the Liver 11/2010; 31(7):971-9. DOI:10.1111/j.1478-3231.2010.02363.x · 4.41 Impact Factor