title: Homeless patients with hepatocellular carcinoma in Osaka City, Japan.
abstract: OBJECTIVE
  Although the number of homeless persons is increasing worldwide, studies delineating the health status of these persons according to various medical perspectives, including hepatology, are limited. However, such studies are important for understanding the pathogenesis of diseases and their prevention.
  
  
  METHODS
  Thirty homeless patients with hepatocellular carcinoma (HCC) and 15 with liver cirrhosis (LC) who were admitted to the Osaka Socio Medical center Hospital during the past 6 years were analyzed clinicopathologically. All were from the Airin district of Osaka City.
  
  
  RESULTS
  The patients with HCC had a history of long stay (mean: 25 years) in the district and many infectious opportunities and most of them were malnourished. The main causes of liver disease in the patients with HCC were hepatitis C virus (HCV) (77%), alcohol abuse (73%), and the combination of HCV and alcohol abuse (50%). Serum HCV RNA concentration was 10(5.8 +/- 0.9) copies/50 microliters in the 21 HCC patients and 10(6.5 +/- 0.7) copies/50 microliters in the 14 LC patients (p < 0.02). Six HCC patients (20%) were positive for the GB virus C/Hepatitis G virus (GBV-C/HGV) RNA in association with HCV or hepatitis B virus (HBV). Only 2 patients with HCC underwent the curative operations and most of the HCC cases were in progressed stages.
  
  
  CONCLUSIONS
  A long stay in a hygiene-poor environment increases the opportunity for infection in homeless people. The causative agents in the HCC and LC patients were mostly HCV, alcohol abuse, and a combination of the two. Since the quantification of HCV-RNA in the HCC patients was lower, the high level of HCV-RNA may not be a risk factor for the development of HCC. GBV-C/HGV may not also. The reversion to former healthy living conditions and reduction in alcohol consumption as soon as possible may contribute to low incidence of HCC and save the tax dollar expenditures among homeless people.
authors.affiliation: Department of Public Health, Osaka City University Medical School, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sakai
authors.forename: S
authors.initials: S
authors.lastname: Seki
authors.forename: S
authors.initials: S
authors.lastname: Nishiguchi
authors.forename: T
authors.initials: T
authors.lastname: Kuroki
authors.forename: T
authors.initials: T
authors.lastname: Kitada
authors.forename: M
authors.initials: M
authors.lastname: Enomoto
authors.forename: K
authors.initials: K
authors.lastname: Satake
authors.forename: T
authors.initials: T
authors.lastname: Monna
mesh_terms: D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000473:pathology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000473:pathology; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology / Q000473:pathology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D019562:Viral Load