Hepatitis B and C in Patients with Hepatocellular Carcinoma in Brazil

Abstract

The relative roles of hepatitis B (HBV) and hepatitis C (HCV) virus infections in primary liver cancer in Brazil have been established. In the present study, the prevalence of HBV and HCV infections was determined in 32 Brazilian patients with hepatocellular carcinoma (HCC), of whom 30 had elevated serum alpha-fetoprotein levels (median 285ng/ml, range 10–1380), but only 14 (44%) were found to have cirrhosis on liver biopsy. Fifteen (47%) had a history of excessive alcohol consumption (>80g/day). All patients were screened for serological markers of HBV (HBsAg, anti-HBe, anti-HBc, and anti-HBs) and of HCV (anti-HCV). Additionally, HBV-DNA was determined by a radiological molecular hybridization assay, and HCV-RNA was measured by nested polymerase chain reaction (PCR). Eight (25%) patients were found to be HBsAg- and anti-HBe- positive, five of whom were seropositive for HBV-DNA. Thirteen (41%) patients were found to have anti-HBs and/or anti-HBc. Anti-HCV was found in 8 (25%), of whom four were HCV-RNA-positive, and one had HBV coinfection (HBsAg- positive). Cirrhotic patients were significantly (P < 0.05) older (mean age 59 years, range 41–77 years) than noncirrhotic patients (mean age 43 years, range 22–68 years), but there was no significant difference between these two groups with respect to overall prevalence of HBV and HCV markers. Nine (28%) of the 32 patients had no markers of HBV or HCV infection and no history of heavy alcohol intake. These findings suggest that, in a significant proportion (56%) of Brazilian patients, HCC develops in noncirrhotic livers and in 50% of these is not related to either HCV or HBV infection or alcohol intake.