Coinfection With Hepatitis B And C Increases Risk of Hepatocellular Carcinoma

WESTPORT, Sep 16 (Reuters Health) - Patients coinfected with the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are at increased risk of developing poorly responsive hepatocellular carcinoma, Japanese oncologists report in the September 1st issue of the journal Cancer.

Dr. Shoji Kubo and colleagues from Osaka City University Medical School determined the clinical significance of prior HBV infection in a group of patients with HCV-related hepatocellular carcinoma. They compared the "...clinicopathologic findings and outcomes after surgery..." of 38 patients with prior HBV infection, as evidenced by the presence of anti-hepatitis B core antigen (anti-HBc), but not HB surface antigen in sera, with those of 22 patients with no serologic evidence of prior HBV infection.

Well-differentiated tumors were seen more often in hepatocellular carcinoma patients with HCV RNA only as opposed to those coinfected with HCV and HBV, Dr. Kubo and colleagues report. The team also discovered that hepatocellular carcinoma "...more often developed before cirrhosis in patients with HCV RNA and anti-HBc than in patients positive for HCV RNA alone."

The investigators also report that HCV-related hepatocellular carcinoma patients with prior HBV infection had a significantly lower cumulative survival rate compared with HCV-related hepatocellular carcinoma patients without HBV infection.

These findings, Dr. Robert C. Kurtz of Memorial Sloan-Kettering Cancer Center in New York says, indicate that "[w]hen there is evidence of HBV and HCV coinfection, the risk of [hepatocellular carcinoma] is much greater and the cancers that develop appear to carry a worse prognosis."

In his editorial, Dr. Kurtz says that patients with chronic HCV infection should undergo serologic testing for prior HBV infection, including anti-HBc. "If serum anti-HBs or anti-HBc is positive, then more aggressive surveillance of these patients for HCC is warranted," he writes.

Dr. Kurtz also suggests, based on the findings of Kubo et al, that patients coinfected with HBV and HCV have serum AFP levels determined every 3 months as opposed to every 6 months, adding that "...persistent elevation in AFP levels should prompt an aggressive imaging search for HCC." [ditto]

Cancer 1999;86:741-743,793-798.