Viral hepatitis among Somali immigrants in Minnesota: association of hepatitis C with hepatocellular carcinoma.
OBJECTIVE
To study the frequencies of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and their associations with hepatocellular carcinoma (HCC) in immigrant Somalis seen at Mayo Clinic in Rochester, Minnesota.


METHODS
We determined the frequencies of HBV and HCV infection and HCC in immigrant Somalis seen at Mayo Clinic from July 1, 1996, through October 31, 2009. Non-Somali Olmsted County residents served as controls.


RESULTS
For Somali males and females, age-adjusted proportions (per 1000 population) were 209 and 123 for hepatitis B surface antigen (HBsAg), 644 and 541 for hepatitis B core antibody (HBcAb), and 99 and 66 for anti-HCV. The comparative proportions in non-Somalis were 20 and 9 for HBsAg, 126 and 97 for HBcAb, and 32 and 17 for anti-HCV. Hepatitis C virus RNA confirmed that 68 of 73 Somalis (93.2%) and 261 of 282 non-Somalis (92.6%) with positive anti-HCV test results had active HCV infection. Of 30 Somali patients with HCC, 22 (73.3%) tested anti-HCV positive (odds ratio [OR], 31.3; 95% confidence interval [CI], 13.0-75.5; P<.001; compared with anti-HCV-negative Somalis), 5 (16.7%) were HBsAg positive (OR, 1.4; 95% CI, 0.5-3.7; P=.53), and 18 (60.0%) were HBcAb positive (OR, 1.8; 95% CI, 0.8-4.2; P=.16). Viral hepatitis was diagnosed coincident with HCC in 9 of 20 patients (45.0%) with HCV-associated HCCs. Only 4 of 24 cases of HCC (16.7%) were detected during surveillance.


CONCLUSIONS
Both HBV and HCV occurred frequently in this sample of Somali immigrants. However, HCV was the major risk factor for HCC. Screening Somali immigrants for HCV infection may enhance the prevention, early detection, and optimal treatment of HCC.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Abdirashid M
AM
Shire
Dalbir S
DS
Sandhu
Joseph K
JK
Kaiya
Abdul M
AM
Oseini
Ju Dong
JD
Yang
Roongruedee
R
Chaiteerakij
Teresa A
TA
Mettler
Nasra H
NH
Giama
Rosebud O
RO
Roberts
Terry M
TM
Therneau
Gloria M
GM
Petersen
Keith L
KL
Knutson
Lewis R
LR
Roberts
D000328:Adult; D017677:Age Distribution; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000208:ethnology* / Q000821:virology; D015897:Comorbidity; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000208:ethnology*; D019698:Hepatitis C, Chronic / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000208:ethnology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010865:Pilot Projects; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012998:Somalia / Q000208:ethnology; D055815:Young Adult