Hepatitis B and C virus infection, alcohol drinking, and hepatocellular carcinoma: a case-control study in Italy. Brescia HCC Study

University of Milan, Milano, Lombardy, Italy
Hepatology (Impact Factor: 11.06). 09/1997; 26(3):579-84. DOI: 10.1002/hep.510260308
Source: PubMed


We performed a case-control study to assess the association of hepatocellular carcinoma (HCC) with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol drinking. We recruited as cases 172 subjects with an initial diagnosis of HCC, who were admitted to the two major hospitals in the province of Brescia, northern Italy, and 332 subjects, sex-, age-, and hospital-matched, who were admitted to the Departments of Ophthalmology, Dermatology, Urology, Cardiology, and Internal Medicine, as controls. Of the HCC cases, 23.8% were positive for HBsAg and 37.8% for HCV RNA; among the controls, 5.4% were positive for HBsAg and 4.8% for HCV RNA. History of heavy alcohol intake (>80 g of ethanol per day for at least 5 years) was found among 58.1% of the cases and among 36.4% of the controls. The relative risks (RRs) for HBsAg, HCV RNA positivity, and heavy alcohol intake were, respectively: 11.4 (95% confidence interval: 5.7-22.8), 23.2 (95% confidence interval: 11.8-45.7), and 4.6 (95% confidence interval: 2.7-7.8). Positive interactions (synergisms) between both HBsAg positivity and HCV RNA positivity and heavy alcohol intake were found, suggesting more than additive effects of viral infections and alcohol drinking on the risk of HCC. Infection with HCV genotype 1b showed a higher risk than type 2 (RR = 2.9; 95% confidence interval: 0.9-10), suggesting a major role for the former type in causing HCC. On the basis of population attributable risks (AR), heavy alcohol intake seems to be the single most relevant cause of HCC in this area (AR: 45%), followed by HCV (AR: 36%), and HBV (AR: 22%) infection.

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    • "Factors associated with rapid disease progression in HBV infected patients include the male gender, increasing age, viraemia with repeated hepatic flares or prolonged periods of liver necroinflammation, and alcohol use; confection with other viruses such as hepatitis C, hepatitis D, and human immunodeficiency virus (HIV); use of immunosuppressive agents, platelets less than 150,000/mL and serum bilirubin more than 1.1 mg/dL (18.8 umol/L) [19–26]. Patients with HBV cirrhosis and active viral replication are at increased risk of developing progressive liver disease and death [4, 27]. "
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    ABSTRACT: Chronic hepatitis B infection progresses from an asymptomatic persistently infected state to chronic hepatitis, cirrhosis, decompensated liver disease, and/or hepatocellular carcinoma. About 3% of patients with chronic hepatitis develop cirrhosis yearly, and about 5% of individuals with hepatitis B cirrhosis become decompensated annually. The outcome for patients with decompensated cirrhosis is bleak. Lamivudine, the first oral antiviral agent available for hepatitis B treatment is safe and effective and can improve or stabilize liver disease in patients with advanced cirrhosis and viraemia. Viral resistance restricts its prolonged use. Entecavir and tenofovir are newer agents with excellent resistance profile to date. These and some other antiviral agents are being investigated for optimal use in this rather challenging patient group.
    Full-text · Article · Jun 2011
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    • "Thus, the incubation period between the onset of HCV infection and the appearance of hepatocellular carcinoma is approximately 2–4 decades. At present, cross-sectional surveys indicate that more than one half of current cases of hepatocellular carcinoma in the US, Europe, and Japan are attributable to HCV infection, and that most patients have cirrhosis.60–62 "
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    ABSTRACT: More than one and half of current cases of hepatocellular carcinoma in the US, Europe, and Japan are attributable to hepatitis C virus (HCV) infection. HCV is also the primary cause of death in patients with HCV-related cirrhosis, with annual incidences of 0.5%-5% in Europe and 4%-10% in Asia. Screening is based on serum alpha-fetoprotein determination and liver ultrasound scan, but the sensitivity of the former is far less than optimal, and screening intervals are still poorly defined for the latter. Risk factors related to the host or environment, or both, appear to be more relevant than viral factors, such as HCV genotype, in determining disease progression to cirrhosis and cancer, and include age, male gender, severity of liver disease at presentation, coinfection with hepatitis B virus or human immunodeficiency virus, and alcohol abuse. Early liver transplantation in selected cases can be curative, but most patients are not eligible for liver grafting and are treated with locoregional ablative therapies, after which recurrence is common. Recently, orally available inhibitors of the vascular endothelial growth factor receptor have shown a significant, albeit modest, increment of survival in patients with advanced hepatocellular carcinoma, thus paving the way for modern molecular approaches to treatment of this highly malignant tumor.
    Full-text · Article · Mar 2011 · Hepatic Medicine: Evidence and Research
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    • "In developing countries, the major concern in HCC frequently belongs to HCV long lasting infection. Chronic HCV infection mostly leads to hepatic cirrhosis before developing HCC (Donato et al., 1997). Additionally, occult HCV was also reported in patients with chronic un-explained hepatitis (Lerat et al., 2004). "
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    ABSTRACT: Hepatocellular carcinoma (HCC) became a prevalent disease in many populations worldwide. It initiates many economic problems in management modalities and leads to increasing mortality rates. Many trials are made all over the world to implement specific early markers for detection and prediction of the disease, hoping to set a more precise strategy for liver cancer prevention. Unfortunately, many economic, cultural and disciplinary levels contribute to confounding preventive strategies. Many risk factors seem to predispose HCC, which either present individually or collectively depending on the environmental situations. Previous articles discussed many risk factors participating in hepatocellular carcinogenesis, although most of them did not handle collectively the current up to date causes. In this article, the pathogenesis and most of risk factors of HCC are briefly discussed. Most of the intermediating steps of HCC pass through molecular and transcriptional events leading eventually to hepatocyte malignant transformation. These steps are mainly triggered by hepatitis B, C or transfusion-transmitted virus, either alone, or with other factors. Diabetes seems to be greatly a leading disease. Schistosomiasis, a blood infestation, mostly disturbs Nile habitants leading also to bladder, renal and hepatic cancers. Alcoholism, food and water pollutants and some other drugs can lead to HCC. Additionally, some hereditary diseases, as hemochromatosis, -1-antitrypsin deficiency and tyrosinaemia are known to develop to HCC, if not discovered.
    Preview · Article · Apr 2009
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