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.