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Presence of antibodies to the hepatitis B surface antigen is associated with an excess risk for hepatocellular carcinoma among non‐Asians in Los Angeles County, California
Author(s) -
Yu M. C.,
Yuan J.,
Ross R. K.,
Govindarajan S.
Publication year - 1997
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510250141
Subject(s) - hbsag , hepatocellular carcinoma , medicine , hepatitis b virus , serology , antibody , hepatitis b , population , virology , immunology , hepatitis c virus , incidence (geometry) , antigen , confidence interval , gastroenterology , virus , environmental health , physics , optics
Hepatocellular carcinoma (HCC) exhibits a more than 50‐fold variation in incidence worldwide. High‐risk regions include East Asia and sub‐Saharan Africa, while non‐Asians in the United States constitute a low‐risk population. We assessed 111 cases of histologically confirmed HCC and 128 community control subjects among non‐Asians of Los Angeles County for the presence in serum of hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti‐HBs), antibodies to the hepatitis B core antigen (anti‐HBc), HBV DNA, and antibodies to the hepatitis C virus (anti‐HCV). Anti‐HCV positivity was significantly associated with a 12.6‐fold increase in HCC risk (95% confidence limits = 4.7, 33.6). As expected, the presence of serum HBsAg and the presence of anti‐HBc in the absence of anti‐HBs were both positively associated with the risk of HCC. But most interestingly, among our study subjects, the presence of anti‐HBs in the absence of HBsAg and HBV DNA (indicative of a resolved infection) was significantly related to a 4.7‐fold increased risk for HCC (95% confidence limits = 2.2, 9.4). Overall, any serological evidence of prior HBV exposure was associated with a 9.4‐fold elevation in HCC risk (95% confidence limits = 4.7, 18.7). The data also demonstrate a synergistic effect of HBV and HCV infections on the risk of HCC. We estimate that about 55% of HCC cases occurring in non‐Asians of Los Angeles can be attributed to infection by the hepatitis B and/or C viruses.