title: Impact of occult hepatitis B virus infection and prior hepatitis B virus infection on development of hepatocellular carcinoma in patients with liver cirrhosis due to hepatitis C virus.
abstract: OBJECTIVE
  Although hepatitis B virus (HBV) DNA can be detected in liver or sera of patients without serum hepatitis B surface antigen (HBsAg), its clinical relevance in hepatocarcinogenesis remains controversial. This observational cohort study was conducted to clarify the risk factors, including the presence of serum HBV DNA and hepatitis B core antibody (anti-HBc), for hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)-related liver cirrhosis (LC).
  
  
  METHODS
  The study comprised 123 patients with LC due to HCV, and negative for HBsAg. The risk factors for HCC development were analyzed by univariate and multivariate analysis. Serum samples were assayed for HBV DNA using real-time polymerase chain reaction.
  
  
  RESULTS
  Serum HBV DNA was detectable in 14 patients (11.4%) and serum anti-HBc in 96 (78.0%). During the follow-up period (mean 53.3 months), 80 patients (65.0%) developed HCC. The cumulative HCC development rate was significantly higher in the anti-HBc-positive group than in the anti-HBc-negative group (p=0.0039), but did not differ between the serum HBV DNA-positive and -negative groups (p=0.8570). The multivariate analysis indicated that male gender, alpha-fetoprotein (AFP) 20 ng/ml or greater, average serum alanine aminotransferase (ALAT) 80 IU/l or greater and the presence of anti-HBc were independent risk factors for development of HCC (p=0.038, p=0.013, p=0.020 and p=0.001, respectively).
  
  
  CONCLUSIONS
  Serum anti-HBc, which indicates a previous HBV infection, has clinical significance in hepatocarcinogenesis in patients with HCV-related LC, but serum HBV DNA does not. Therefore, anti-HBc in serum is a significant predictor for HCC.
authors.affiliation: Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. dm04002y@st.kitasato-u.ac.jp
authors.forename: Shigeru
authors.initials: S
authors.lastname: Adachi
authors.forename: Akitaka
authors.initials: A
authors.lastname: Shibuya
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Miura
authors.forename: Atsuko
authors.initials: A
authors.lastname: Takeuchi
authors.forename: Takahide
authors.initials: T
authors.lastname: Nakazawa
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000821:virology*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006508:Hepatitis Antibodies / Q000097:blood; D006509:Hepatitis B / Q000150:complications*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology*; D008113:Liver Neoplasms / Q000150:complications / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D004279:DNA, Viral; D006508:Hepatitis Antibodies; D006512:Hepatitis B Core Antigens; D000509:alpha-Fetoproteins; D000410:Alanine Transaminase