title: Viral genotypes and associated risk factors of hepatocellular carcinoma in India.
abstract: OBJECTIVE
  This study aims to investigate the etiological relationship among hepatitis B virus (HBV), hepatitis C virus (HCV), and alcohol as risk factors in a cohort of hepatocellular carcinoma (HCC) patients from India. The clinical and biochemical profiles and tumor characteristics in the HCC cases were also evaluated.
  
  
  METHODS
  A total of 357 consecutive cases of HCC fulfilling the diagnostic criteria from the Barcelona-2000 EASL conference were included in the study. The blood samples were evaluated for serological evidence of HBV and HCV infection, viral load, and genotypes using serological tests, reverse transcription-polymerase chain reaction, and restriction fragment length polymorphism.
  
  
  RESULTS
  The male/female ratio for the HCC cases was 5.87:1. Majority of the HCC patients (33.9%) were 50 to 59 years of age, with a mean age of 4±13.23 years. More than half the cases (60.8%) had underlying cirrhosis at presentation. Among the HCC patients, 68.9% were HBV related, 21.3% were HCV related, 18.8% were alcoholic, and 18.2% were of cryptogenic origin. The presence of any marker positive for HBV increased the risk for developing HCC by almost 27 times [OR: 27.33; (12.87-60.0)]. An increased risk of 10.6 times was observed for HCC development for cases positive for any HCV marker [OR: 10.55; (3.13-42.73)]. Heavy alcohol consumption along with HCV RNA positivity in cirrhotic patients was found to be a risk for developing HCC by 3 folds [OR: 3.17; (0.37-70.71)].
  
  
  CONCLUSIONS
  Patients of chronic HBV infection followed by chronic HCV infection were at higher risk of developing HCC in India. Chronic alcohol consumption was found to be a risk factor in cirrhotic cases only when it was associated with HCV RNA positivity. Most of the patients had a large tumor size (>5 cm) with multiple liver nodules, indicating an advanced stage of the disease thus making curative therapies difficult.
authors.affiliation: PCR Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi 110002, India.
authors.forename: Manash Pratim
authors.initials: MP
authors.lastname: Sarma
authors.forename: Mohammad
authors.initials: M
authors.lastname: Asim
authors.forename: Subhash
authors.initials: S
authors.lastname: Medhi
authors.forename: Thayumanavan
authors.initials: T
authors.lastname: Bharathi
authors.forename: Richa
authors.initials: R
authors.lastname: Diwan
authors.forename: Premashis
authors.initials: P
authors.lastname: Kar
keywords: hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; risk factors