Hepatitis B and C viruses in the etiology of hepatocellular carcinoma; a study in Greece using third-generation assays

Objectives: The purpose of this study was to describe the role of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of hepatocellula r carcinoma (HCC). Methods: During a 4-year period from January 1995 to December 1998, blood s amples and questionnaire data were obtained from 333 incident cases of HCC from Athens, Greece, as well as from patients in two control groups, also f rom Athens. Controls were 272 metastatic liver cancer (MLC) patients and 36 0 patients hospitalized for injuries or eye, ear, nose or throat conditions . Coded sera were tested for hepatitis B surface antigen (HBsAg) and antibo dies to hepatitis C virus (anti-HCV) by third-generation enzyme immunoassay s. Results: The odds ratios (with 95% confidence intervals) in logistic regres sion modeling comparing the HCC cases to the combined control series were 4 8.8 (30.5-78.3) for the presence of HBsAg and 23.2 (11.4-47.3) for the pres ence of anti-HCV. The odds ratio for concurrent infection with HBV and HCV was 46.2 (9.9-216.6) compared to infection with neither virus. Conclusions: Although HBV and HCV are both important causes of HCC in this study population the data do not suggest, neither do they conclusively refu te, a super-additive interaction between the two infections in the developm ent of this malignancy. In this population, 58% of HCC cases can be attribu ted to HBV, 12% to HCV, and 3% to dual infection with these viruses.