IMPACT OF INTERFERON-ALPHA THERAPY ON THE DEVELOPMENT OF HEPATOCELLULAR-CARCINOMA IN PATIENTS WITH LIVER-CIRRHOSIS - RESULTS OF AN INTERNATIONAL SURVEY

Clinico-epidemiological data show that the most severe forms of hepati tis C virus (HCV) associated liver disease occur in patients with mult ifactorial liver damage. We found that the prevalence of hepatitis B v irus (HBV) markers in anti-HCV positive patients with cirrhosis compli cated by hepatocellular carcinoma (HCC) is higher than in cirrhotics w ith comparable age and disease history, but without HCC. HBV can persi st in integrated forms in HBsAg negative, anti-HBc positive individual s and we may speculate that in such patients concurrent liver pathogen s, as HCV, could cause HCC more easily than in patients without previo us exposure to HBV, Analysing the relations between age at I-ICC diagn osis and the different risk factors in consecutive HCC patients we fou nd that patients with single hepatitis virus infections (HBsAg and/or anti-HCV positive) were of an older median age than patients with mult iple hepatitis virus infections. We also studied patients with compens ated cirrhosis and hepatitis virus infections, untreated or treated wi th interferon-alpha, The independent effect of treatment was analysed by matching groups with regard to all the other significant HCC risk f actors, The overall relative HCC risk was three times higher (risk rat io 3.1) in untreated vs treated anti-HCV positive patients and more th an six times higher (risk ratio 6.2) in untreated vs treated anti-HCV positive/anti-HBc negative patients. The difference between treated an d untreated patients was not statistically significant in hepatitis B surface antigen carriers and in anti-HCV positive/anti-HBc positive pa tients. The evidence that HBV coinfection may worsen the course of liv er cirrhosis in patients with chronic hepatitis C is intriguing, but i t has important practical consequences, It warrants the identification of high risk patients with chronic hepatitis C who need to be treated as early as possible and patients who can still benefit from interfer on-alpha therapy once cirrhosis has already been diagnosed.