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Clinicopathological study of occult hepatitis B virus infection in hepatitis C virus-associated hepatocellular carcinoma

El-Maksoud, Mohamed A.a; Habeeb, Maha R.b; Ghazy, Hayam F.c; Nomir, Manal M.e; Elalfy, Hatema; Abed, Sallya; Zaki, Maysaa E.S.d

European Journal of Gastroenterology & Hepatology: June 2019 - Volume 31 - Issue 6 - p 716–722
doi: 10.1097/MEG.0000000000001388
Original Articles: Hepatology

Background Occult hepatitis B virus infection (OBI) frequently occurs in patients with chronic hepatitis C (CHC) infection, but the influence of OBI on CHC outcome is still uncertain. The aim of the present study was to clarify the clinical and pathological characteristics of OBI in CHC-related hepatocellular carcinoma (HCC).

Patients and methods DNA was obtained from serum and tumor tissue of patients with hepatitis C virus (HCV)-related HCC with negative HBsAg and from patients with HCV-related liver cirrhosis. HBV-DNA was detected using qPCR. Clinicopathological features were compared between patients with HCC with and without OBI.

Results On the basis of positive serum and tissue HBV-DNA typing, the overall frequency of OBI was 50% in patients with HCV-related HCC. HBV genotype D was the most dominant, constituting 35.3% of HCC cases. Almost 80% of patients with OBI had anti-HBc, whereas 20% of patients had no serological markers. Tissue HBV-DNA showed significant association with positive serum HBV-DNA, anti-HBc, and genotype D. There were no clinical differences between patients with HCC with and without OBI; however, patients with OBI tended to be younger. HCC cases with positive OBI were significantly associated with positive anti-HBc antibodies and late histological grades (3–4). Multivariate logistic regression analysis revealed that the presence of OBI was a predictor of more advanced HCC histological grades in patients with HCV infection.

Conclusion OBI was detected in 50% of HCV-infected patients with HCC. OBI was strongly associated with the presence of anti-HBc antibodies. Patients with HCC with positive OBI were younger and had more advanced HCC histological grades.

Departments of aTropical Medicine

bInternal Medicine

cMedical Oncology

dClinical Pathology, Mansoura Faculty of Medicine

eClinical Pathology Student’s Hospital, Mansoura University, Mansoura, Egypt

Correspondence to Hatem Elalfy, MD, Department of Tropical Medicine, Faculty of Medicine, Mansoura University, 35516 Mansoura, Egypt Tel/fax: +20 122 479 0518; e-mail:

Received December 21, 2018

Accepted February 11, 2019

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