Viral pathogenesis of hepatocellular carcinoma in the United States

Hepatology. 1993 Dec;18(6):1326-33.


Chronic hepatitis B virus infection is closely associated with the development of hepatocellular carcinoma, which is a major cause of cancer death worldwide. Recent studies have implicated hepatitis C virus infection as a major pathogenic agent of HBsAg-negative hepatocellular carcinoma. The significance of hepatitis C virus and hepatitis B virus infections in the occurrence of HBsAg-negative hepatocellular carcinoma has not been well established in the United States. We studied 91 HBsAg-negative American patients with hepatocellular carcinoma for evidence of hepatitis C virus or hepatitis B virus infection. These patients had no other predisposing factors to hepatocellular carcinoma. A sensitive polymerase chain reaction was employed to detect hepatitis C virus RNA and hepatitis B virus DNA in serum and liver. Three sets of hepatitis C virus and hepatitis B virus primers were used to optimize the detection of viral genomes. Hepatitis C virus antibodies were measured with second-generation immunoassays. Twenty-six (29%) of these patients carried low levels of hepatitis B virus DNA in either serum, liver/tumor tissue or both. On the basis of the results from serological and polymerase chain reaction analyses of serum and liver, we found that 53 of 91 patients (58%) exhibited evidence of hepatitis C virus infection. When data were combined, 14 patients (15%) had evidence of hepatitis B virus/hepatitis C virus coinfection, whereas 12 (13%) were infected with hepatitis B virus alone and 39 (43%) had hepatitis C virus only. Twenty-six (29%) had no markers of hepatitis B virus or hepatitis C virus infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Hepatocellular / epidemiology
  • Carcinoma, Hepatocellular / etiology*
  • Cohort Studies
  • DNA, Viral / analysis
  • Female
  • Hepacivirus / genetics
  • Hepacivirus / isolation & purification
  • Hepatitis B / complications*
  • Hepatitis B / epidemiology
  • Hepatitis B / microbiology
  • Hepatitis B virus / genetics
  • Hepatitis B virus / isolation & purification
  • Hepatitis C / complications*
  • Hepatitis C / epidemiology
  • Hepatitis C / microbiology
  • Humans
  • Immunoblotting
  • Liver / microbiology
  • Liver Neoplasms / epidemiology
  • Liver Neoplasms / etiology*
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Prevalence
  • RNA, Viral / analysis
  • United States / epidemiology


  • DNA, Viral
  • RNA, Viral