Homeless patients with hepatocellular carcinoma in Osaka City, Japan

BACKGROUND/AIMS: Although the number of homeless persons is increasing worl dwide,studies delineating the health status of these persons according to v arious medical perspectives, including hepatology, are limited. However, su ch studies are important for understanding the pathogenesis of diseases and their prevention. METHODOLOGY: Thirty homeless patients with hepatocellular carcinoma (HCC) a nd 15 with liver cirrhosis (LC)who were admitted to the Osaka Socio Medical Center Hospital during the past 6 years were analyzed clinicopathologicall y. All were from the Airin district of Osaka City. RESULTS: The patients with HCC had a history of long stay (mean: 25 years) in the district and many infectious opportunities and most of them were mal nourished. The main causes of liver disease in the patients with HCC were h epatitis C virus (HCV)(77%), alcohol abuse (73%), and the combination of HC V and alcohol abuse (50%). Serum HCV RNA concentration was 10(5.8+/-0.9) co pied/50 mu l in the 21 HCC patients and 10(6.5+/-0.7):Copies/50 mu l in, th e 14 LC patients (p<0.02). Six HCC patients (20%)were positive for the GB v irus C/Hepatitis G virus (GBV-C/HGV) RNA in association with HCV or hepatit is B virus (HBV). Only 2 patients with HCC underwent the curative operation s and most of the HCC cases were in progressed stages. CONCLUSIONS: Along stay in a hygiene-poor environment increases the opportu nity for infection in homeless people. The causative agents in the HCC anal LC patients were mostly HCV, alcohol abuse, and a combination of the two. Since the quantification of HCV-RNA in the HCC patients was lower, the high level of HCV-RNA may not be a risk factor for the development of HCC, GBV- C/HGV may not also. The reversion former healthy living conditions and redu ction in alcohol. consumption as soon as possible may contribute to low inc idence of HCC and save the tax dollar expenditures among homeless people.