title: Occult hepatitis B virus infection is associated with the development of hepatocellular carcinoma in chronic hepatitis C patients.
abstract: BACKGROUND
  Occult hepatitis B virus (HBV) infection frequently occurs in patients with HBV surface antigen (HBsAg)-negative chronic liver disease, and much evidence suggests that it is a risk factor for hepatocellular carcinoma (HCC) development. However, to the authors' knowledge, no follow-up study has been performed to date evaluating HCC occurrence over time in chronic hepatitis patients with or without occult HBV infection.
  
  
  METHODS
  A cohort of the 380 HBsAg-negative chronic hepatitis patients attending the study institution between 1991-2000 were evaluated and tested for occult HBV DNA by analysis of liver biopsy specimens.
  
  
  RESULTS
  There were 135 patients (35.5%) with occult HBV and 245 patients (64.5%) without occult HBV. Cirrhosis was significantly associated with occult HBV infection (P = 0.01). One hundred thirty-four of these patients were followed for a minimum of 50 months (median, 82.8 +/- 32.6 mos). Fifty-three patients (39%) were occult HBV carriers and 81 (61%) were not. Nine patients developed HCC during the follow-up; eight were positive and one was negative for occult HBV (P = 0.002).
  
  
  CONCLUSIONS
  The current observational cohort study showed that, among the HBsAg-negative patients with chronic hepatitis, HCC develops for the most part in carriers of occult HBV. Therefore, the evaluation of HBV genomes in chronic hepatitis patients appears to be a powerful tool for the identification of individuals at higher risk of HCC development.
authors.affiliation: Unit of Clinical and Molecular Hepatology, Department of Internal Medicine, University of Messina, 98124 Messina, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Squadrito
authors.forename: Teresa
authors.initials: T
authors.lastname: Pollicino
authors.forename: Irene
authors.initials: I
authors.lastname: Cacciola
authors.forename: Gaia
authors.initials: G
authors.lastname: Caccamo
authors.forename: Daniela
authors.initials: D
authors.lastname: Villari
authors.forename: Tiziana
authors.initials: T
authors.lastname: La Masa
authors.forename: Tea
authors.initials: T
authors.lastname: Restuccia
authors.forename: Eugenio
authors.initials: E
authors.lastname: Cucinotta
authors.forename: Claudio
authors.initials: C
authors.lastname: Scisca
authors.forename: Domenico
authors.initials: D
authors.lastname: Magazzu
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raimondo
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D015897:Comorbidity; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D006509:Hepatitis B / Q000175:diagnosis* / Q000453:epidemiology; D006514:Hepatitis B Surface Antigens / Q000032:analysis / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000821:virology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens