HEPATITIS-C VIRUS-INFECTION AS A MAJOR RISK FACTOR FOR HEPATOCELLULAR-CARCINOMA

Evidence of a tumorigenic potential of the hepatitis C virus (HCV) has so far come mainly from epidemiological data, Longitudinal studies ha ve shown that 16 of 62 anti-HCV antibody (ab)-positive Japanese patien ts developed hepatocellular carcinoma (HCC) within 5 yr. HCC-related d eaths were significantly (p = 0.01) higher in Swedish anti-HCV ab-posi tive patients than in anti-HCV ab-negative controls (18 vs, 4%), The r elative frequency of anti-HCV ab in HCC patients has been reported to be as high as 72% in Spain, 49-62% in Italy and 58% in France, It rang es between 9 and 36% in the USA and is about 26% in Germany, In HBV-en demic areas like South East Asia and Equatorial Africa, HCV-related HC Cs play a minor role, The relative risk of developing HCC was elevated (up to 69.1-fold) for anti-HCV ab-positive patients as compared to an ti-HCV ab-negative controls in almost all geographic areas studied to date, There is some evidence for an increased risk of developing HCC w hen hepatitis B virus (HBV) coinfection is present, Cirrhosis is likel y to represent an additional risk factor for the development of HCC in anti-HCV ah-positive patients, Blood transfusions are the source of i nfection in barely one third of anti-HCV ab-positive HCC patients, The re seems to be no significant difference in age or gender between anti -HCV ab-positive and ab-negative HCC patients, The additional impact o f alcohol consumption and of the HCV genotype is presently under inves tigation, On the molecular level, HCV replication intermediates have b een detected in HCC tissue and point mutations within the p53 gene hav e been demonstrated, However, the pathomechanism leading to HCV-mediat ed cell transformation remains unsolved. (C) European Association for the Study of the Liver.