The Gambia Liver Cancer Study: Infection with hepatitis B... : Hepatology (original) (raw)

Original Articles

The Gambia Liver Cancer Study: Infection with hepatitis B and C and the risk of hepatocellular carcinoma in West Africa

Kirk, Gregory D.*,1,2,†; Lesi, Olufunmilayo A.2, 7; Mendy, Maimuna4; Akano, Aliu O.5, 7; Sam, Omar5; Goedert, James J.1; Hainaut, Pierre3; Hall, Andrew J.6; Whittle, Hilton4; Montesano, Ruggero3

1 Viral Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD

2 International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Banjul, The Gambia

3 International Agency for Research on Cancer, Gambia Hepatitis Intervention Study, Lyon, France

4 Medical Research Council Laboratories, Banjul, The Gambia

5 Department of Medical Services, Royal Victoria Hospital, Government of The Gambia, Banjul, The Gambia

6 London School of Hygiene and Tropical Medicine, London, UK

7 Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Radiodiagnosis, National Hospital, Abuja, Nigeria

E-mail:[email protected]

*Address reprint requests to: Viral Epidemiology Branch, DCEG/NCI, 6120 Executive Boulevard, EPS-8003, MSC-7248, Bethesda, MD 20892

†fax: 301-402-0817

Received July 17, 2003; accepted October 11, 2003; previously published online January 05, 2004

Abstract

Hepatocellular carcinoma (HCC) is the most common cancer in The Gambia. Hepatitis B virus (HBV) infection is endemic, with 15% to 20% of the population being chronic carriers, whereas hepatitis C virus (HCV) prevalence is low. We recruited 216 incident cases of HCC and 408 controls from three sites. HBV carriage was present in 61% (129/211) of HCC patients and 16% (64/402) of controls, whereas 19% (36/191) of HCC patients were HCV seropositive compared with 3% (11/382) of controls. HCC patients with HCV were notably older and were more likely to be female than those with HBV. Increased HCC risk was strongly associated with chronic HBV (odds ratio, 16.7; 95% CI, 9.7-28.7), HCV (16.7; 6.9-40.1), and dual infection (35.3; 3.9-323). We interpret the additive nature of risk with coinfection as representative of HBV and HCV acting primarily through shared steps in the multistage process of hepatocarcinogenesis. HCV infection was not observed among younger participants, suggesting a possible cohort effect. Reasons for the striking age and gender differences in HCC associated with HBV compared with HCV are unclear, but transmission patterns and age at exposure may be factors. In conclusion, in a standardized evaluation of well-characterized study participants from The Gambia, most cases of HCC are attributable to HBV (57%), but HCV adds a significant fraction (20%), especially among older patients and females. If HCV transmission is not perpetuated in future cohorts, focusing available resources on HB vaccination efforts could greatly ameliorate a major cause of cancer death in sub-Saharan Africa. (Hepatology 2004;39:211-219.).