HCV AND HBV COEXIST IN HBSAG-NEGATIVE PATIENTS WITH HCV VIREMIA - POSSIBILITY OF COINFECTION IN THESE PATIENTS MUST BE CONSIDERED IN HBV HIGH ENDEMIC AREA

Hepatocellular carcinoma (HCC) is one of the most common cancers and i s highly associated with hepatitis B virus (HBV) infection in Korea. T he role of HBV and hepatitis C virus (HCV) in HCC patients who are neg ative for hepatitis B surface antigens (HBsAg) remains poorly defined. It has been suggested that HCV core protein may impair the polymerase activity of HBV in vitro, potentially lowering HBV titre in coinfecte d patients. Therefore, routine enzyme immunoassay may not detect HBV, in spite of the presence of HBV viraemia in low titres. The aim of thi s study was to confirm the coexistence of HBV viraemia in hepatitis C- infected patients with HCC who have apparent HBsAg seronegativity and to establish the need for clinical reinterpretation of enzyme immunoas say (EIA) serological tests of HBsAg in patients with HCV viraemia and HCC. The serological profiles of HBV and HCV in 616 patients with HCC were analysed and the coinfection rate of HCV and HBV investigated. S era were obtained from 16 patients who were both anti-HCV and HCV-RNA positive but HBsAg negative, and tested for HBV by polymerase chain re action (PCR). Eleven non-A and non-B chronic hepatitis patients withou t HCC who had the same profiles of anti-HCV, HCV-RNA, and HBsAg were t ested for HBV by PCR. As a control group, sera were obtained from 15 p atients with HCC and 30 non-A and non-B chronic hepatitis patients wit hout HCC; both were anti-HCV, HCV-RNA, and HBsAg negative and tested f or HBV PCR. Of the 616 patients with HCC, 450 (73.1%) had current HBV infection, 48 (7.8%) had anti-HCV antibodies, and nine (1.5%) had vira l markers of both HCV and HBV by serological profiles. Of the 27 patie nts with HCV viraemia and HBsAg seronegativity (16 with HCC; 11 with n on-A non-B chronic hepatitis), 14 (51.9%) showed HBV viraemia by PCR. In contrast, of the 75 patients in the control group (45 with HCC; 30 with non-A and non-B chronic hepatitis) who were both HCV PCR negative and HBsAg negative, five (11.1%) showed HBV viraemia by PCR. The PCR for HBV revealed coexistent HBV viraemia in HCV viraemia patients, des pite HBsAg negativity by EIA. In HBV-endemic areas, the possibility of coinfection of HBV in HBsAg-negative patients with HCV viraemia shoul d be considered and molecular analysis for HBV-DNA performed.