"When R. Palmer Beasley, MD, lived in Taiwan in the mid-1970s, his daily workplace was a US Naval research installation in Taipei. But outside the laboratory, in the communities around him, Dr. Beasley was intrigued by the high rates of two serious liver diseases: hepatitis B (HBV) and liver cancer. Dr. Beasley, then a member of the University of Washington Medical School faculty, began to suspect a correlation between the two, and he set about testing this hypothesis with the same scientific rigor he brought to all his work.
"From the outset, many in the scientific community were skeptical. In the United States, President Richard M. Nixon's 'War on Cancer' reflected a strong focus on environmental causes of cancer; the idea of a link between viruses and cancer had fallen out of favor. In part, this was because previous efforts to establish such a connection had failed. [Sic - notice how this writer goes PC and blames Nixon for the 'War on Cancer' that the Lasker Syndicate got by flagrantly manipulating the public and the government, including Nixon through his "Kitchen Cabinet" advisor Elmer Bobst. Likewise, the Lasker Syndicate controlled the research agenda because they controlled the money, and it is not even clear that Nixon had any opinions of his own on the subject. -cast]
"'When people had thought which cancers might have a viral cause, it was thought that leukemia was a good candidate and a variety of others, but solid tumors of the GI tract were not on anybody's horizon,' Dr. Beasley says. 'When I came along and said viruses again, it was like the door had been shut on that notion.' Best of all, as a result of the vaccination of newborns, "The virus carrier rate among Taiwanese children has declined from about 12 percent to 1 percent. Liver cancer rates are also dropping."Beasley / Hepatitis Magazine 2000
Beasley later collaborated with the Lasker
in the establishment of the Medicine and Public Health alliance. While
the CDC's SAMMEC eventually removed liver cancer from their list of
related diseases," they continue to falsely blame smoking for other
diseases that are also really caused by infection.
From the International Agency for Research on Cancer, Monograph 59, Hepatitis B Virus (Summary):
5.0 Summary of Data Reported and Evaluation
"... The presence of HBsAg or HBV DNA indicates current HBV
infection. The presence of HBeAg indicates a high level of viral
replication. Seroconversion to anti-HBe is usually associated with
reductions in replication and in disease activity. The presence
immunoglobulin M class anti-HBc indicates acute HBV infection; the
immunoglobulin G class anti-HBc appears after acute HBV infection and
persists during chronic HBV infection... Infection perinatally and in
early childhood is the major risk factor for chronicity, which
frequently leads to chronic liver disease and cirrhosis."
"In 15 cohort studies, carrier status for HBV was determined
presence of HBsAg in serum. In all studies, the risk for hepatocellular
carcinoma increased in association with HBsAg seropositivity, with
estimates of relative risk ranging from 5.3 to 148. Many case-control
studies have been reported on the association between hepatocellular
carcinoma and chronic infection with HBV, as determined by HBsAg
positivity. Most of the studies were conducted in Asia and in Africa,
but some have been reported from Europe and North America. The studies
were of variable quality, but the majority showed a strong association,
with relative risks between 5 and 30. Potential confounding by
aflatoxin, infection with hepatitis C virus, cigarette smoking and
alcohol drinking appears to have been excluded in studies in which
those factors were evaluated." [Sic - as if the danger is of false
risks attributed to HBV due to confounding by smoking, instead of the
opposite direction! -cast]
5.5 Evaluation There is sufficient evidence in humans for the carcinogenicity of chronic infection with hepatitis B virus.
Overall evaluation Chronic infection with hepatitis B virus is carcinogenic to humans (Group 1).IARC Monograph 59 Hepatitis Viruses - summary (1994) / IARC (pdf, 8 pp)
Toxicology Program of
the National Institute of Environmental Health Sciences belatedly
classifies HBV as a known human carcinogen. "First listed
Eleventh Report on
(2004)." This is ten years after the IARC did so.
From the International Agency for Research on Cancer, Monograph 59, Hepatitis C Virus (Summary):
"Infection with HCV, as indicated by the presence of
HCV in serum, appeared to be associated with an increased risk for
hepatocellular cancer in two cohorts of patients with chronic liver
disease and one cohort of patients from the general population. Over 20
case-control studies have evaluated the association between
hepatocellular carcinoma and seropositivity for HCV antibodies,
measured either by first- or second-generation tests. Odds ratio
estimates ranging from 1.3 to 134 were observed in 17 studies in which
first-generation tests were used and were significant in 15 of the
studies. In six studies in which second-generation tests were used, the
estimated odds ratios ranged from 1.1 to 52 and were significant in
three of the studies. In all 11 studies in which it could be evaluated,
the risk for hepatocellular carcinoma was greater in subjects who were
seropositive for HCV and seronegative for hepatitis B surface antigen
than in subjects seronegative for both. In the few studies in which the
analysis took into account possible confounding of the effects of HCV
by other risk factors for hepatocellular carcinoma, such as smoking
[SIC] and alcohol consumption, the association was not materially
There is sufficient
in humans for the carcinogenicity of chronic infection with hepatitis C
infection with hepatitis C virus is carcinogenic
to humans (Group 1)."
The National Toxicology Program of the National Institute of Environmental Health Sciences belatedly classifies HCV as a known human carcinogen. "First listed in the Eleventh Report on Carcinogens (2004)." This is ten years after the IARC did so.Hepatitis C Virus, 2004 / NIEHS (pdf, 2pp)
Human oncogenic viruses: hepatitis B and hepatitis C viruses and their role in hepatocarcinogenesis. VE Gurtsevitch. Biochemistry (Mosc) 2008 May;73(5):504-513.Gurtsevitch / Biochemistry (Mosc) 2008 full article
Diagnosis of hepatitis B virus infection through serological
virological markers. JH Kao. Expert Rev Gastroenterol Hepatol 2008
Aug;2(4):553-562. "The natural history of chronic HBV infection can be
divided into four dynamic phases in HBV carriers who acquire the virus
early in life. Diagnosis of HBV infection is usually through
serological and virological markers. Hepatitis B surface antigen
(HBsAg) is the hallmark of HBV infection and is the first serological
marker to appear in acute hepatitis B, and persistence of HBsAg for
more than 6 months suggests chronic HBV infection. Hepatitis B e
antigen (HBeAg) usually indicates active HBV replication and risk of
transmission of infection. Recently, occult HBV infection is recognized
as the absence of circulating HBsAg in individuals positive for serum
or tissue HBV DNA, irrespective of other HBV serological markers.
Meanwhile, monitoring the serum HBV DNA level is valuable for assessing
liver disease activity, differentiating other etiologies of hepatitis
activity in HBV carriers, predicting risk of HCC development or
liver-related mortality, deciding to administer antiviral therapy,
determination of the response to antiviral treatment, predicting the
risk of developing drug resistance, and detecting the emergence of
drug-resistant mutants. On the other hand, HBV genotype C, basal core
promoter mutant and pre-S deletion mutant are reported to be associated
with increased risk of HCC development. The roles of quantitative HBV
serology and intrahepatic HBV covalently closed circular (ccc)DNA
deserve further studies."
Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. BD Smith, RL Morgan, GA Beckett, Y Falck-Ytter, D Holtzman, CG Teo, A Jewett, B Baack, DB Rein, N Patel, M Alter, A Yartel, JW Ward; Centers for Disease Control and Prevention. MMWR Recomm Rep 2012 Aug 17;61(RR-4):1-32. 45%-85% of the 3.9 million persons with HCV infection in the U.S. are unaware of their status. Persons born during 1945-1965 are about 27% of the population, but account for three fourths of all HCV infections; their HCV antibody prevalence is 3.25%. HCV-associated disease is the leading indication for liver transplantation. They recommend testing for Hepatitis C antibodies and for nucleic acid (HCV RNA).Smith / MMWR Recomm Rep 2012 full article
Eradication of Hepatitis C Virus Infection and the Development of Hepatocellular Carcinoma: A Meta-analysis of Observational Studies. RL Morgan, B Baack, BD Smith, A Yartel, M Pitasi, Y Falck-Ytter. Ann Intern Med 2013 Mar 5;158(5 Pt 1):329-337. "Thirty studies fulfilled the inclusion criteria, and 18 provided adjusted effect estimates that were used to calculate pooled relative risks. Among HCV-infected persons, [sustained virologic response] was associated with reduced risk for HCC (relative risk for all persons, 0.24 [95% CI, 0.18 to 0.31], moderate-quality evidence; advanced liver disease hazard ratio, 0.23 [CI, 0.16 to 0.35], moderate-quality evidence)."Morgan / Ann Intern Med 2013 full article
Since the 1990s, there have been major advances in the detection of hepatitis B virus infection in epidemiologic studies. The old way was to look for hepaitis B surface antigen (HBsAg) alone. Patients without HBsAg were considered HBV negative. It has now been shown to be necessary to look for the core antigen (HBcAg), and attempt to find HBV DNA in tissue samples as well, to more completely determine the presence of HBV infection.
Hepatitis C virus is believed to cause liver cancer also, and
found HCV DNA by reverse transcriptase PCR in patients who were
negative for antibodies to HCV. Due to the high odds ratios for liver
cancer associated with HBV and HCV, and the unequal distribution of
exposure between smokers and nonsmokers, failure to fully detect the
viruses results in a bogus risk that is associated with smoking due to
Hepatitis B virus DNA in the serum of Sardinian blood donors
negative for the hepatitis B surface antigen. ME Lai, P Farci, A Figus,
A Balestrieri, M Arnone, GN Vyas. Blood 1989 Jan;73(1):17-19. "Among
the 71 subjects positive for serum HBV DNA, 22 (31%) were positive for
anti-HBc, while 49 (69%) were negative for all serologic markers of HBV
infection." There had been several reports of this, dating back to
1981, including one in the New England Journal of Medicine in 1985.
Detection of hepatitis B virus DNA by polymerase chain
plasma of volunteer blood donors negative for hepatitis B surface
antigen. JT Wang, TH Wang, JC Sheu, LN Shih, JT Lin, DS Chen. J Infect
Dis 1991 Feb;163(2):397-399. "Plasma samples from 206 volunteer blood
donors were tested for hepatitis B virus (HBV) DNA by dot blot
hybridization and polymerase chain reaction (PCR). All donors were
negative for hepatitis B surface antigen (HBsAg) and had normal serum
alanine aminotransferase levels. None of the 206 plasma samples was
positive for HBV DNA by dot blot hybridization assay. However, nine
samples were positive for HBV DNA by PCR using two primer pairs
specific for surface and core regions. Nine persons received the
HBV-DNA-positive plasma, and one developed posttransfusion non-A, non-B
hepatitis; the others remained well 6 months later."
Impact of HBV, HCV and GBV-C/HGV on hepatocellular carcinomas in Europe: results of a European concerted action. C Brechot, F Jaffredo, D Lagorce, G Gerken, K Meyer zum Buschenfelde, A Papakonstontinou, S Hadziyannis, R Romeo, M Colombo, J Rodes, J Bruix, R Williams, N Naoumov. J Hepatol 1998 Aug;29(2):173-183. HBV DNA was detected in the serum and liver of 33% and 47% of HBsAg negative patients, and in the serum of 25.1% who were "without any HBV marker." They also found HCV RNA by R-PCR in 7% of anti-HCV negatives. "It also stresses the need to use genome detection in epidemiological studies when serological tests are negative."Brechot - J Hepatol 1998 abstract / PubMed
High prevalence of infection with hepatitis B and C viruses in patients with hepatocellular carcinoma in Japan. S Kubo, S Nishiguchi, K Hirohashi, H Tanaka, T Tsukamoto, H Hamba, T Shuto, T Okuda, A Tamori, T Kuroki, H Kinoshita. Hepatogastroenterology 1999 Jan-Feb;46(25):357-359. "Hepatitis B virus genes were detected in 13 patients with anti-surface antibody, in 21 of 30 patients with anti-core antibody, and in 9 of 22 patients without hepatitis B antibodies. Viral genes were detected in tumor tissue in 5 of 11 patients with neither B nor C virus markers in their sera; viral markers were found in either serum or tumor tissue in 324 of 330 patients (98.2%)."Kubo - Hepatogastroenterology 1999 abstract / PubMed
[Prevalence of HCV and HBV infection in patients with primary
hepatocellular carcinoma in Shanxi Province]. J Wang, H Zhao, S Zhao.
Chung Hua Liu Hsing Ping Hsueh Tsa Chih 1999 Aug;20(4):215-217. In a
regression analysis on 98 patients assessing numerous serological
markers, Wang et al. found odds ratios for antibodies to HCV of 55.06;
for HBsAg of 10.8; for anti-HBc of 9.85; and for both anti-HCV and
HBsAg of 61.37. These high ORs have a high potential to produce
spurious results due to confounding.
High prevalence of anti-hepatitis B virus serological markers in patients with hepatitis C related chronic liver disease in Japan. H Marusawa, Y Osaki, T Kimura, K Ito, Y Yamashita, T Eguchi, M Kudo, Y Yamamoto, H Kojima, H Seno, F Moriyasu, T Chiba. Gut 1999 Aug;45(2):284-288. A large proportion (49.9%) of patients with HCV-related chronic liver disease were also positive for antibodies to HBc. "Notably, anti-HBc was the only serological marker for HBV infection in a significant number of patients with HCV-related chronic liver disease (24.1%), and especially those with hepatocellular carcinoma."Marusawa - Gut 1999 abstract / PubMed
Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis. R Chiesa, F Donato, A Tagger, M Favret, ML Rivero, G Nardi, U Gelatti, E Bucella, E Tomasi, N Portolani, M Bonetti, L Bettini, G Pelizzari, A Salmi, A Savio, M Garatti, F Callea. Cancer Epidemiol Biomarkers Prev 2000 Feb;9(2):213-216. In 174 newly-diagnosed liver cancer patients, according to positivity for HCV RNA, HBsAg and/or HBV DNA, and alcohol intake >80g/day, the odds ratios with 95% confidence intervals, with and without cirrhosis, were HCV RNA 33.5 (17.7-63.4) and 19.7 (6-64.8); HBsAg 17.6 (9.0-34.4) and 20.3 (5.7-72.6); alcohol 5.5 (3.1-9.7) and 4.6 (1.5-13.8). And, "No association was found with HGV or TT virus infections or tobacco."Chiesa - Cancer Epidemiol Biomarkers Prev 2000 abstract / PubMed
Virologic analysis of non-B, non-C hepatocellular carcinoma in Japan: frequent involvement of hepatitis virus. H Yotsuyanagi, Y Shintani, K Moriya, H Fujie, T Tsutsumi, T Kato, K Nishioka, T Takayama, M Makuuchi, S Iino, S Kimura, K Koike. J Infect Dis 2000 Jun;181(6):1920-1928. HBV DNA was found by PCR in the sera of 47.6% of liver cancer patients with supposedly "non-B, non-C" hepatitis. In twelve with liver tissues available, HBV DNA detection was 67%.Yotsuyanagi - J Infect Dis 2000 abstract / PubMed
Occult hepatitis B virus infection in HBs antigen-negative
hepatocellular carcinoma in a Japanese population: involvement of HBx
and p53. G Shiota, K Oyama, A Udagawa, K Tanaka, T Nomi, A Kitamura, A
Tsutsumi, N Noguchi, Y Takano, K Yashima, Y Kishimoto, T Suou, H
Kawasaki. J Med Virol. 2000 Oct;62(2):151-158. "Serum DNA was amplified
by nested PCR by using specific primers of surface (S), core (C) and X
regions in 26 patients negative for HBsAg and anti-HCV. Eighteen (69%)
patients were positive for either S, C, or X region and the results of
PCR were confirmed by Southern blotting."
Correlation of clinical characteristics with detection of
B virus X gene in liver tissue in HBsAg-negative, and HCV-negative
hepatocellular carcinoma patients. Y Higashi, S Tada, S Miyase, K
Hirota, H Imamura, T Kamio, H Suko. Liver. 2002 Oct;22(5):374-379.
About half of non-B non-C hepatocellular carcinoma patients were
seronegative for HBsAg but positive for the HBV-X gene in liver tissue.
Dominant role of hepatitis B virus and cofactor role of
hepatocarcinogenesis in Qidong, China. L Ming, SS Thorgeirsson, MH
Gail, P Lu, CC Harris, N Wang, Y Shao, Z Wu, G Liu, X Wang, Z Sun.
Hepatology 2002 Nov;36(5):1046-1049. 100% of 181 incident HCCs
markers for HBV (HBsAg, anti-HBc, or HBV X gene
co-infected with HCV.
Geographic Characterization of Hepatitis Virus Infections,
Genotyping of Hepatitis B Virus, and p53 Mutation in Hepatocellular
Carcinoma Analyzed by In Situ Detection of Viral Genomes from Carcinoma
Tissues: Comparison among Six Different Countries. X Ding, YN Park, TC
Taltavull, SN Thung, X Jin, Y Jin, NS Trung, Y Edamoto, T Sata, K Abe.
Jpn J Infect Dis 2003 Feb;56(1):12-18. 449 patients with HCC. "HBV was
the most prevalent in Korea (69.1%), China (66.1%), Vietnam (60.5%),
and Spain (38.6%). In contrast, HCV was the most prevalent in Japan
(59.8%) and in the United States (41.5%). Type C of HBV was the most
common genotype (78.6%) encountered in HCC in these countries.
Importantly, among 125
intrahepatic HBV DNA-positive patients, 44 (35.2%) were serologically
negative for HBsAg (occult hepatitis B). Furthermore, 15.5% of HCC
patients (9/58) who were negative for all HBV markers had
intrahepatic HBV DNA." "Based on PCR, immunohistochemical, serological,
and clinical findings, 4.8% of HCC patients were diagnosed with non-B,
of hepatitis viruses B and C were not found in only 6.2% of American
cases, and about 5% overall. "Histological
findings of non-B, non-C
showed that 81% of cases were accompanied by liver cirrhosis and 62.5%
had chronic inflammatory cell infiltration in the portal tracts of
nontumorous regions, which findings suggested persistent infection by
Molecular and serological aspects of HBsAg-negative hepatitis B virus infections in North America. CC Hsia, CH Scudamore, AM Di Bisceglie, E Tabor. J Med Virol 2003 May;70(1):20-26. In 31 HBsAg-negative HCC patients, "HBV DNA was detected in HCC and/or in adjacent nontumorous liver tissue using nested polymerase chain reaction (PCR) in 5/9 (56%) patients from the United States and in 12/22 (55%) from Canada. The 17 HBV DNA-positive/HBsAg-negative patients from the United States and Canada included 9 without any serological markers for HBV and 8 with detectable antibodies to hepatitis B core antigen. In these patients, HBV genotype C was the most prevalent genotype (11/17; 64%). HBV genotypes have not been previously reported in HCC patients from North America." Due to undetected evidence of HBV infection, "those with antibody to hepatitis C virus (HCV) would otherwise have been designated 'HCV-associated HCCs' based on serological tests alone."Hsia - J Med Virol 2003 / PubMed abstract
Prevalence of HBV precore/core promoter variants in the United States. CJ Chu, EB Keeffe, SH Han, RP Perrillo, AD Min, C Soldevila-Pico, W Carey, RS Brown Jr., VA Luketic, N Terrault, AS Lok, U.S. HBV Epidemiology Study Group. Hepatology 2003 Sep;38(3):619-628. "Precore and core promoter variants were more common in hepatitis B e antigen (HBeAg)-negative than in HBeAg-positive patients (precore, 38% vs 9%; core promoter, 51% vs 36%, respectively, P <.001)... Physicians should be aware of the existence of precore and core promoter variants and the clinical condition of 'HBeAg-negative chronic hepatitis.'"Chu - Hepatology 2003 abstract / PubMed
Hepatitis B virus maintains its pro-oncogenic properties in
of occult HBV infection. T Pollicino, G Squadrito, G Cerenzia, I
Cacciola, G Raffa, A Crax, F Farinati, G Missale, A Smedile, C
Tiribelli, E Villa, G Raimondo. Gastroenterology. 2004
Jan;126(1):102-10. "We tested tumor tissues from 107 patients with HCC
and the corresponding nontumor liver tissue from 72 of these patients
for HBV DNA. We also examined liver specimens from 192 patients with
chronic hepatitis. All cases were hepatitis B surface antigen
negative... Viral DNA was detected in 68 of 107 cases of HCC (63.5%)
and in 63 of 192 cases of chronic hepatitis (32.8%) (P < 0.0001;
odds ratio, 3.6; 95% confidence interval, 2.2-5.9)... CONCLUSIONS: Our
provide clear evidence that occult HBV is a risk factor for development
of HCC and show that the
potential mechanisms whereby overt HBV might induce tumor formation are
mostly maintained in cases of occult infection."
Tight association of hepatocellular carcinoma with HBV infection in North China. JD Gao, YF Shao, Y Xu, LH Ming, ZY Wu, GT Liu, XH Wang, WH Gao, YT Sun, XL Feng, LM Liang, YH Zhang, ZT Sun. Hepatobiliary Pancreat Dis Int 2005 Feb;4(1):46-49. "RESULTS: In the 119 HCC patients, 82.4% (98/119) were HBsAg seropositive. When a comprehensive set of HBV markers were detected, the HBV infection rate in these HCC patients was 99.2% (118/119). Of the patients, 11.8% (14/119) were found to be anti-HCV positive. But all the anti-HCV positive HCC patients were co-infected with HBV. CONCLUSIONS: HBV infection is virtually ubiquitous in HCC patients in North China. The tight association of HBV with HCC strongly suggests the dominant role of HBV infection in causing hepatocellular carcinoma. About 11.8% of HCC patients being HCV-related are co-infected with HBV."Gao -Hepatobiliary Pancreat Dis Int 2005 abstract / PubMed
HBsAg-negative hepatitis B virus infections in hepatitis C
virus-associated hepatocellular carcinoma. S Momosaki, Y Nakashima, M
Kojiro, E Tabor. J Viral Hepat 2005 May;12(3):325-329. "Thirty newly
diagnosed HCC patients from Kurume, Japan, with antibody to the
hepatitis C virus (anti-HCV) were studied. None of the 30 had HBsAg
detectable in their serum. Of 22 for whom test results for antibodies
to the hepatitis B core antigen (anti-HBc) and antibodies to HBsAg
(anti-HBs) were available, 14 (64%) had anti-HBc and anti-HBs, four
(18%) had anti-HBc alone, and four (18%) had no HBV markers. Nested
polymerase chain reaction was used to detect the HBV surface (S), core
(C), polymerase (P) and core promoter gene sequences in the HCC tissues
and in the adjacent nontumorous liver tissues. HBV DNA was detected in
HCC and/or adjacent nontumorous liver in 22 of 30 (73%) patients
[detected in both HCC and nontumorous liver in 19/30 patients (63%)].
Among the 22 patients with detectable HBV DNA, more than one HBV gene
was detected in 10 (46%). Among the four patients whose sera were
negative for all HBV markers, three had HBV DNA in either HCC and
nontumorous liver (two cases) or only in the nontumorous liver (one
case); HBV DNA could not be detected in tissues from the fourth
patient. In 18 of 21 (86%) patients with detectable HBV core promoter
sequences, mutations at both nucleotides 1762 (A-GT) and 1764 (G-A) in
the core promoter region were found... Thus, HBV DNA was detectable in
22 (73%) HBsAg-negative, anti-HCV-positive HCCs, including three (10%)
who were also negative for anti-HBc and anti-HBs."
Significance of HBV DNA in the hepatic parenchyma from
non-B, non-C hepatocellular carcinoma. T Nakai, O Shiraishi, T Kawabe,
H Ota, H Nagano, H Shiozaki. World J Surg 2006 Jul;30(7):1338-1343.
"Nonneoplastic liver tissue from 46 patients with non-B, non-C HCC were
examined for hepatitis B virus (HBV) DNA and HCV RNA using in situ
hybridization... HBV DNA was detected in nonneoplastic liver specimens
from 35 patents (76.1%), whereas HCV RNA was not detected in any case."
Patients with higher HBV DNA expression had a worse outcome.
Lengths of hepatitis B viremia and antigenemia in blood
preliminary evidence of occult (hepatitis B surface antigen-negative)
infection in the acute stage. A Yoshikawa, Y Gotanda, K Minegishi, R
Taira, S Hino, K Tadokoro, H Ohnuma, K Miyakawa, K Tachibana, H
Mizoguchi; Japanese Red Cross NAT Screening Research Group. Transfusion
2007 Jul;47(7):1162-1171. "The Japanese Red Cross (JRC) implemented a
fully automated pooling and nucleic acid amplification test (NAT)
system for testing seronegative donations. The JRC sample repository
and repeat blood donations allowed for lookback and follow-up studies
of hepatitis B virus (HBV) DNA-positive donors, who tested negative for
hepatitis B surface antigen (HBsAg) and anti-hepatitis B core antigen
in the JRC screening system... 328 HBV DNA-positive donations were
found. From 26 of these donors, sequential samples were available at
short intervals... Six of the 26 donors were infected with mutant
viruses, and 3 of these 6 donors did not develop detectable HBsAg
during the entire observation period, despite a moderately high viral
load of 10(4) to 10(5) HBV DNA copies per mL."
Hepatitis B virus DNA in liver tissue and risk for
hepatocarcinogenesis in patients with hepatitis C virus-related chronic
liver disease. A prospective study. M Obika, T Shinji, S Fujioka, R
Terada, H Ryuko, AA Lwin, H Shiraha, N Koide. Intervirology
2008;51(1):59-68. 167 patients with HCV-related chronic liver disease
without HBV surface antigen (HBsAg). "HBV DNA was detected in 9 of 167
patients (5.4%) by single PCR and in 25 patients (15.0%) by nested PCR.
HCC developed in 12 of 167 patients (7.2%). Ten of 142 HBV DNA-negative
patients (7.0%) and 2 of 9 patients with a high HBV copy number (22.2%)
developed HCC, whereas none of 16 patients with a low HBV copy number
A case-control study of the relationship between hepatitis B
DNA level and risk of hepatocellular carcinoma in Qidong, China. TT
Liu, Y Fang, H Xiong, TY Chen, ZP Ni, JF Luo, NQ Zhao, XZ Shen. World J
Gastroenterol 2008 May 21;14(19):3059-3063. Prospective study of 2387
participants who were seropositive for HBsAg and confirmed to be free
of HCC by AFP level and abdominal ultrasonography were followed up with
abdominal ultrasonography and serological tests including ALT, AFP, HBV
serological markers (HBsAg) and anti-Hepatitis C virus (HCV) antibody
until February 2006. 186/276 (67.4%) samples of control subjects had
undetectable levels of serum HBV DNA. 73/243 HCC cases who were
diagnosed with HCC within two years were excluded, leaving 170 cases.
"Compared with those with undetectable levels of serum HBV DNA, the
adjusted odds ratios of HCC for subjects with increasing HBV DNA level
were 0.465 (95% CI 0.172-1.259), 2.834 (1.237-6.492), 48.403
(14.392-162.789), 42.252 (14.784-120.750), and 14.819 (6.992-31.411)."
Impact of occult hepatitis B virus infection and prior
virus infection on development of hepatocellular carcinoma in patients
with liver cirrhosis due to hepatitis C virus. S Adachi, A Shibuya, Y
Miura, A Takeuchi, T Nakazawa, K Saigenji. Scand J Gastroenterol
2008;43(7):849-856. 123 patients with LC due to HCV, and negative for
HBsAg. "Serum HBV DNA was detectable in 14 patients (11.4%) and serum
anti-HBc in 96 (78.0%). During the follow-up period (mean 53.3 months),
80 patients (65.0%) developed HCC. The cumulative HCC development rate
was significantly higher in the anti-HBc-positive group than in the
anti-HBc-negative group (p=0.0039), but did not differ between the
serum HBV DNA-positive and -negative groups (p=0.8570)."
Survival and hepatitis status among Asian Americans with
hepatocellular carcinoma treated without liver transplantation. JP
Hwang, MM Hassan. BMC Cancer 2009 Feb 4;9:46. Of 82 patients, "94% had
positive anti-HBc and 61% had positive HBsAg. 20% had positive
anti-HCV. There were no significant changes in the rates of HBV and HCV
over time." [Hassan
fraudulent study that ignored HBV in order to falsely blame smoking.]
Frequent detection of hepatitis B virus DNA in hepatocellular
carcinoma of patients with sustained virologic response for hepatitis C
virus. A Tamori, T Hayashi, M Shinzaki, S Kobayashi, S Iwai, M Enomoto,
H Morikawa, H Sakaguchi, S Shiomi, S Takemura, S Kubo, N Kawada. J Med
Virol 2009 Jun;81(6):1009-1014. "Study group comprised 16 patients with
sustained virologic response (group A) and 50 with HCV (group B).
Anti-HBc and anti-HBs in serum were examined by enzyme-linked
immunoassay. HBV DNA in liver was examined by nested polymerase chain
reaction, using primers specific for genes encoding for HBx, HBsAg,
HBcAg, and HBV cccDNA. Sequence of the amplified HBV DNA for 'a'
determinant of HBsAg was determined in HCC. Anti-HBc was positive in 10
of 16 in group A and 25 of 50 in group B. HBV DNA in liver was detected
in 12 of 16 in group A and 21 of 50 in group B (P = 0.044)."
Occult hepatitis B virus infection increases hepatocellular
carcinogenesis by eight times in patients with non-B, non-C liver
cirrhosis: a cohort study. K Ikeda, M Kobayashi, T Someya, S Saitoh, T
Hosaka, N Akuta, F Suzuki, Y Suzuki, Y Arase, H Kumada. J Viral Hepat
2009 Jun;16(6):437-443. In 82 consecutive Japanese patients
observed for a median of 5.8 years, "The carcinogenesis rates in the
patients with positive DNA group and negative DNA group were 27.0% and
11.8% at the end of the 5th year, and 100% and 17.6% at the 10th year,
respectively (P = 0.0078)."
Clearance of hepatitis B surface antigen and risk of
carcinoma in a cohort chronically infected with hepatitis B virus. J
Simonetti, L Bulkow, BJ McMahon, C Homan, M Snowball, S Negus, J
Williams, SE Livingston. Hepatology 2010 May;51(5):1531-1537.
A prospective population-based cohort study in 1,271 Alaska Native
persons with chronic HBV infection followed for an average of 19.6
years. "Six patients, two with cirrhosis and four without, developed
HCC a mean of 7.3 years after HBsAg clearance (range, 2.0-15.5 years).
The incidence of HCC after clearance of HBsAg was 36.8 per 100,000 per
year (95% CI 13.5-80.0) which was significantly lower than the rate in
those who remained HBsAg-positive (195.7 cases per 100,000 person-years
of follow-up [95% CI 141.1-264.5; P < 0.001]). After loss of
HBV DNA was detected in the sera of 28 (18%) of those who cleared a
median of 3.6 years after clearance."
Hepatitis B surface antigen-negative, but HBV DNA-positive patients in Bangladesh. MA Mahtab, SM Akbar, S Rahman. Bangladesh Med Res Counc Bull 2012 Dec;38(3):104-107. "HBV DNA was detected in 8 of 20 patients with cryptogenic liver cirrhosis, 1 of 10 patients with hepatocellular carcinoma, and 2 of 10 apparent healthy subjects with elevated ALT. However, all of them were negative for HBsAg in the sera."Mahtab - Bangladesh Med Res Counc Bull 2012 abstract / PubMed
Hepatitis B viral DNA among HBs antigen negative healthy blood donors. M Vaezjalali, S Rashidpour, H Rezaee, B Hajibeigi, M Zeidi, L Gachkar, S Aghamohamad, R Najafi, H Goudarzi. Hepat Mon 2013 Mar 17;13(3):e6590. 1000 serum specimens negative for HBsAg, "80 out of 1000 samples (8%) were found to be positive for HBcAb. HBV DNA was detected in 50% of HBcAb positive specimens."Vaezjalali - Hepat Mon 2013 full article / PubMed Central
Molecular analysis of the hepatitis B virus presurface and surface gene in patients from eastern China with occult hepatitis B. X Huang, Y Qin, W Li, Q Shi, Y Xue, J Li, C Liu, FB Hollinger, Q Shen. J Med Virol 2013 Jun;85(6):979-986. 254 HBsAg negative, 28 HBsAg positive blood samples from HBV patients. "Occult hepatitis B was found in 1.6% of the patients with anti-HBc alone and in 3.3% of those with anti-HBe alone. Occult hepatitis B also was found in all HBsAg negative but HBeAg positive samples. Sequencing analysis showed a significant correlation between point mutations within the 'a' determinant and occult hepatitis B (P < 0.0001), and a close relationship between pre-S deletion mutations and occult hepatitis B (P = 0.06). There were unique amino acid mutations at the G145 position other than G145R. The HBV DNA levels in patients with occult hepatitis B were significantly lower than those found in the control group."Huang - J Med Virol 2013 abstract / PubMed
Occult and Overt HBV Co-Infections Independently Predict Postoperative Prognosis in HCV-Associated Hepatocellular Carcinoma. ML Chang, YJ Lin, CJ Chang, C Yeh, TC Chen, TS Yeh, WC Lee, CT Yeh. PLoS One 2013 Jun 21;8(6):e64891. 115 HCV patients, 35 with overt and 16 with occult HBV. "[P]resence of occult HBVCI (AHR, 2.708 [1.317∼5.566]), and absence of overt HBVCI (AHR, 2.216 [1.15∼4.269]) were independently associated with unfavorable disease-free survival. Patients with occult HBVCI had a shorter disease-free (P = 0.002), a shorter overall survival (P = 0.026), a higher bilirubin level (P = 0.003) and a higher prevalence of precore G1896A mutation (P = 0.006) compared with those with overt HBVCI."Chang - PLoS One 2013 full article / PubMed Central
High Prevalence of Occult Hepatitis C Virus Infection in Patients with Chronic Hepatitis B Virus Infection. I Castillo, J Bartolomé, JA Quiroga, V Carreño. J Med Microbiol 2013 Aug;62(Pt 8):1235-1238. "HCV-RNA was tested in the liver samples of 52 patients with chronic HBV infection and 21 (40%) of them were positive for viral RNA (occult HCV infection). Liver fibrosis was found more frequently and the fibrosis score was significantly higher in patients with occult HCV than in negative ones, suggesting that occult HCV infection may have an impact on the clinical course of HBV infection."Castillo - J Med Microbiol 2013 abstract / PubMed
Pathological characteristics of patients who develop hepatocellular carcinoma with the negative results of both serous hepatitis B surface antigen and hepatitis C virus antibody. R Kondo, O Nakashima, M Sata, F Imazeki, O Yokosuka, K Tanikawa, M Kage, H Yano; Liver Cancer Study Group of Kyushu. Hepatol Res 2013 Aug 13 [Epub ahead of print]. 129 patients. "Positivity of serum hepatitis B core (HBc) antibody, alcohol abuse, diabetes, and nonalcoholic steatohepatitis were present in 61 (47%), 76 (59%), 57 (44%), and 8 (6%) patients, respectively... The stage of patients with neither serum HBc antibody nor alcohol abuse was significantly lower than the stage of patients with HBc antibody and no alcohol abuse (p < 0.05). HBV genome was detected in 15 cancerous tissues (75%) and 16 non-cancerous liver tissues (80%) in 20 patients with non-B non-C HCC. Only 3 of the 20 patients were positive for serum HBc antibody."Kondo - Hepatol Res 2013 abstract / PubMed
Impact of Occult Hepatitis B Virus Infection on the Outcome of Chronic Hepatitis C. G Squadrito, I Cacciola, A Alibrandi, T Pollicino, G Raimondo. J Hepatol 2013 Oct;59(4):696-700. 326 chronic Hepatitis C patients (128 with occult HBV and 198 without). "Eighteen patients (13/37 OBI positive, 5/57 OBI negative, p<0.01) developed hepatocellular carcinoma (HCC). Among the 76 non-HCC individuals, 15 subjects (8/24 OBI positive, 7/52 OBI negative, p<0.05) developed advanced forms of cirrhosis. Eighteen patients died during the follow-up and 2 underwent liver transplantation. OBI positive individuals had a cumulative survival rate significantly shorter than OBI negative individuals (P=0.003). Liver-related deaths were more frequently found in OBI positive than OBI negative patients (12/37 OBI positive vs 6/57 OBI negative patients respectively, p<0.01). Finally, non-response to anti-HCV therapy was significantly associated with lower survival (p=0.02)."Squadrito - J Hepatol 2013 abstract / PubMed
Rare occurrence of occult hepatitis C virus in apparently uninfected injecting drug users: a two-centre, masked, case-control study. PB Sugden, TN Pham, S Ratnarajah, B Cameron, R Bull, PA White, TI Michalak, AR Lloyd; HITS investigators. J Viral Hepat 2013 Oct;20(10):725-728. 35 cross-sectional and 32 longitudinal subjects. "Two [apparently uninfected] subjects in the first study (10%) and one in the second study (3%) were found to have consistently detectable HCV RNA."Sugden - J Viral Hepat 2013 abstract / PubMed
Viral hepatitis markers in liver tissue in relation to serostatus in hepatocellular carcinoma. BY Hernandez, X Zhu, SA Kwee, O Chan, N Tsai, G Okimoto, D Horio, KA McGlynn, SF Altekruse, LL Wong. Cancer Epidemiol Biomarkers Prev 2013 Nov;22(11):2016-2023. 61 U.S. HCC cases of known serologic status. "Tissue viral and serologic status were discordant in 27 (44%) cases, including those with apparent 'occult' infection. Specifically, HBV DNA was detected in tissue of 4 of 39 (10%) serum HBsAg (-) cases, including 1 anti-HCV(+) case; and HCV RNA was detected in tissue of 3 of 42 (7%) anti-HCV seronegative cases, including 2 with serologic evidence of HBV. Conclusions. Viral hepatitis, including HBV-HCV coinfection, may be unrecognized in up to 17% of HCC patients when based on serology alone," and "The contribution of HBV and HCV to the rising incidence of HCC in the United States may be underestimated."Hernandez - Cancer Epidemiol Biomarkers Prev 2013 abstract / PubMed
Latent hepatitis B is a risk factor for hepatocellular carcinoma in patients with chronic hepatitis C. A Reddy, E May, M Ehrinpreis, M Mutchnick. World J Gastroenterol 2013 Dec 28;19(48):9328-9333. 185 patients with HCC who were HCV antibody (+) and HBsAg(-), 356 controls without HCC. "More patients with HCC had LHB than controls (78% vs 39%, P = 0.01). Sixty three percent of patients with HCC were both hepatitis B surface antigen (HBsAb)(-) and HBcAb(+) compared to 23% of controls (P < 0.01). When compared to cirrhotic controls, the frequency of HBcAb(+) remained higher in patients with HCC (78% vs 45%, P = 0.02). Patients with HCC were more likely to be both HBsAb(-) and HBcAb(+) than the cirrhotic controls (63% vs 28%, P = 0.01). Although not statistically significant, 100% of CHC and HIV co-infected patients with HCC (n = 11) were HBcAb(+) when compared to controls (44%; n = 9)."Reddy - World J Gastroenterol 2013 full article / PubMed Central
The clinical significance of occult HBV infection. G Squadrito, R Spinella, G Raimondo. Ann Gastroenterol 2014;27(1):15-19. Review.Squadrito - Ann Gastroenterol 2014 full article / PubMed Central
Occult Hepatitis B Virus Infection among Iranian Blood Donors: A Preliminary Study. Z Alizadeh, S Milani, Z Sharifi. Arch Iran Med 2014 Feb;17(2):106-107. "Four hundred ninety nine (9.98%) out of the 5000 HBsAg negative blood donors were anti-HBc positive. Out of 499 anti-HBc positive samples that were tested for anti-HBs, 394 (78.4 %) were anti-HBs positive, and 275 (62.7%) had an antibody titer greater than 100 IU/mL. HBV DNA was detected in two samples."Alizadeh - Arch Iran Med 2014 abstract / PubMed
Prevalence and molecular analysis of occult hepatitis B virus infection isolated in a sample of cryptogenic cirrhosis patients in iran. FA Anvari, SM Alavian, M Norouzi, M Mahabadi, SM Jazayeri. Oman Med J 2014 Mar;29(2):92-96. "Hepatitis B virus DNA was detected in 38% of patients, all of whom had a viral load below 10,000 copies/mL. All hepatitis B virus belonged to genotype D. There were no significant associations between occult hepatitis B virus infection status and age, gender, ALT/AST levels, viral load or serologic markers of previous hepatitis B virus infection."Anvari - Oman Med J 2014 abstract / PubMed
Hepatitis B virus nucleic acid amplification testing of Australian blood donors highlights the complexity of confirming occult hepatitis B virus infection. P Kiely, AR Margaritis, CR Seed, H Yang; Australian Red Cross Blood Service NAT Study Group. Transfusion 2014 Mar 20 [Epub ahead of print]. 2,673,521 blood donations. "Of the 42 OBI cases, 23 (54.8%) were detected the first time they were screened for HBV DNA while 19 (45.2%) gave one or more HBV NAT-nonreactive results before detection. Of 68 donors initially assessed as HBV inconclusive and available for follow-up, 10 later confirmed as OBI cases while 51 were NAT nonreactive but remained anti-HBc reactive and OBI could not be excluded... This study demonstrated a substantially higher prevalence of OBI compared to acute serologic window period HBV infections in Australian blood donors. Follow-up testing of OBI cases indicates that HBV DNA is often only intermittently detectable in OBI, highlighting the importance of including anti-HBc to optimize the HBV testing algorithm."Kiely - Transfusion 2014 abstract / PubMed
Seroprevalence of occult hepatitis B among Egyptian paediatric hepatitis C cancer patients. HE Raouf, AS Yassin, SA Megahed, MS Ashour, TM Mansour. J Viral Hepat 2014 Apr 23 [Epub ahead of print]. Numbers of patients and controls not given in abstract. "Occult hepatitis B infection was observed in neither the non-HCV paediatric cancer patients nor the paediatric noncancer patients but was found in 31% of the HCV-positive paediatric cancer patients. All the detected HBV patients belonged to HBV genotype D, and mutations were found in the surface genome of HBV leading to occult HBV."Raouf - J Viral Hepat 2014 abstract / PubMed
Occult hepatitis B virus and hepatocellular carcinoma. T Pollicino, C Saitta. World J Gastroenterol 2014 May 28;20(20):5951-5961. Review.Pollicino - World J Gastroenterol 2014 full article / PubMed Central
Occult HBV infection in Morocco: from chronic hepatitis to hepatocellular carcinoma. B Kitab, S Ezzikouri, R Alaoui, S Nadir, W Badre, C Trepo, I Chemin, S Benjelloun. Liver Int 2014 Jul;34(6):e144-150. Of 152 HBsAg-negative patients, 24/60 (40%) of patients with cryptogenic hepatitis, 57/92 (61.95%) with HCV infection, and 62.5% of patients with HCC were positive for HBc.Kitab - Liver Int 2014 abstract / PubMed
Risk factors for hepatocellular carcinoma among patients with
chronic liver disease. H Tsukuma, T Hiyama, S Tanaka, M Nakao, T
Yabuuchi, T Kitamura, K Nakanishi, I Fujimoto, A Inoue, H Yamazaki, et
al. N Engl J Med 1993 Jun 24;328(25):1797-1801. The only markers
considered were HBsAg, anti-HBc, and anti-HCV.
The role of previous hepatitis B virus infection and heavy
in hepatitis C virus-related hepatocellular carcinoma. T. Chiba, Y
Matsuzaki, M Abei, J Shoda, N Tanaka, T Osuga, T Aikawa. Am J
Gastroenterol 1996 Jun;91(6):1195-1203. The investigators state that
"We prospectively observed 412 patients with anti-HCV-positive CLD but
co-infection of hepatitis B virus [emphasis added] (232
with chronic hepatitis and 180 with liver cirrhosis) for between 0.5
and 15.8 yr (median: 4.9 yr)." Then, they claim to have founds risks
"2-fold in patients with positive antibodies against hepatitis B
surface antigen and/or antibodies against hepatitis B core antigen
(risk ratio, 2.14; 95% confidence interval, 1.13-4.07, p = 0.0201), and
2.5-fold in heavy smokers (risk ratio, 2.46; 95% confidence interval,
1.11-5.49, p = 0.0276)." First, the two statements obviously contradict
each other. Second, they must have failed to detect some cases of HBV
infection because they did not look for HBV DNA. A substantial
proportion of patients with no HBV markers in serum nevertheless have
HBV DNA; and given the high odds ratios associated with HBV, small odds
ratios of 2-3 are easily created by confounding. Nevertheless, this is
one of the favorite pieces of "evidence" among anti-smokers for
claiming that smoking causes liver cancer.
This is a classic example of confounding, as demonstrated by Phillips & Smith (Cigarette smoking as a potential cause of cervical cancer: Has confounding been controlled? Int J Epidemiol 1994 Feb;23:42-49). That purported "stronger association" in ostensibly HBV- and HCV-negative patients is the result of speciously blaming smoking for HCC in false negatives, due to the different rates of exposure between smokers and nonsmokers. They did not look at positivity by HBcAg or PCR! And their vaunted "significant dose-response, positive association" with smoking overall is a bogus risk generated from residual confounding by the statistical calculation itself, as Phillips & Smith showed.
Yet here is a disgraceful statement in a review by FX Bosch
ought to know better), et al. (Epidemiology of primary liver cancer.
Semin Liver Dis 1999;19(3):271-285): "Other documented risk factors
such as... cigarette smoking... may explain the residual variation
between and within countries." These are not legitimate claims, because
the studies were defective.
Has Bosch already forgotten his own confirmation of Phillips & Smith's model of how smoking is falsely blamed for another disease actually caused by viral infection (Int J Epidemiol 1994;23:1100-1101)? Or does he fail to understand that their model is just as applicable to hepatitis viruses as to human papillomaviruses?
The ORs claimed for smoking and liver cancer are similar to those falsely claimed for smoking and cervical cancer, while the ORs for hepatitis viruses are far higher than the OR of 10 assumed in Phillips & Smith's model. The conventional methods of detection of HBV and HCV used in epidemiologic studies have been shown to be incomplete, thus the existence of confounding is a certainty.
Othrwise, according to this review, "The role of chronic infection with the hepatitis B and hepatitis C viruses (HBV and HCV) in the etiology of LC is well established. The attributable risk estimates for LC for each of these hepatotropic viruses varies among countries but the combined effects of persistent HBV or HCV infections account for well over 80% of LC cases worldwide." (And this is by those inadequate methods that miss many cases and falsely blame them on smoking.)
They acknowledge that "New laboratory techniques and biological markers such as polymerase chain reaction detection of HBV DNA and HCV RNA, as well as specific mutations related to aflatoxin exposure may help to provide quantitative estimates of the risks related to each of these factors." However, the same purveyors of anti-smoking junk science, such as those in the National Cancer Institute and the Centers for Disease Control, who have ignored and concealed the incontrovertible caveats relating to cervical cancer, can be counted on to do the same concerning liver cancer. And only the objections of an informed public can quash them.
Chronic liver diseases for the risk of hepatocellular
case-control study in Japan. Etiologic association of alcohol
consumption, cigarette smoking and the development of chronic liver
diseases. M Mukaiya, M Nishi, H Miyake, K Hirata.
Hepatogastroenterology 1998 Nov-Dec;45(24):2328-2332. The biomarkers
used are not given in the abstract. According to IARC 83, they
considered only HBsAg and anti-HCV.
A long-term follow-up study on risk factors for hepatocellular
carcinoma among Japanese patients with liver cirrhosis. K Tanaka, H
Sakai, M Hashizume, T Hirohata. Jpn J Cancer Res 1998
Dec;89(12):1241-1250. Only HBsAg, anti-HCV, and HCV-RNA titer
HBV/HCV Infection, Alcohol, Tobacco and Genetic Polymorphisms
Hepatocellular Carcinoma in Nagoya, Japan. T Koide, T Ohno, XE Huang, Y
Iijima, K Sugihara, M Mizokami, J Xiang, S Tokudome. Asian Pac J Cancer
Prev 2000;1(3):237-243. The biomarkers used are not stated in the
abstract. The OR for hepatitis B virus was 5.14
(95%CI=2.29-11.6) and hepatitis C virus 32.00 (95%CI=7.83-130.7), while
a history of blood transfusion was 5.25 (95%CI=1.80-15.29), and
habitual smoking 2.36 (95%CI=1.17-4.78). Both of the later were likely
confounded by undetected infection; after all, blood transfusions can
only cause liver cancer via infection, so it can be inferred that
insufficient biomarkerts were used.
Prospective study on the relation of cigarette smoking with
of the liver and stomach in an endemic region. T Mizoue, N Tokui, K
Nishisaka, S Nishisaka, I Ogimoto, M Ikeda, T Yoshimura. Int J
Epidemiol 2000 Apr;29(2):232-237. This study considered no biomarkers
whatsoever for either hepatitis viruses or stomach infections, and its
mere publication reflects the dishonesty of the editors of the journal,
who in 2006 include George Davey-Smith, co-author of a paper
demonstrating how confounding
exactly such circumstances.
Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: a cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in Taiwan. LY Wang, SL You, SN Lu, HC Ho, MH Wu, CA Sun, HI Yang, C Chien-Jen. Cancer Causes Control. 2003 Apr;14(3):241-250. Again, they tested only for HBsAg and anti-HCV, and fraudulently claimed to have found a risk associated with smoking.Wang - Cancer Causes Control 2003 abstract / PubMed
Incidence and cofactors of hepatitis C virus-related hepatocellular carcinoma: a prospective study of 12,008 men in Taiwan. CA Sun, DM Wu, CC Lin, SN Lu, SL You, LY Wang, MH Wu, CJ Chen. Am J Epidemiol 2003 Apr 15;157(8):674-682. These data appear to be the same as Wang 2003. Likwise, the only infection markers evaluated were HCV antibody (anti-HCV) and hepatitis B surface antigen (HBsAg).Sun - Am J Epidemiol 2003 abstract / PubMed
Synergism of alcohol, diabetes, and viral hepatitis on the risk of hepatocellular carcinoma in blacks and whites in the U.S. JM Yuan, S Govindarajan, K Arakawa, MC Yu. Cancer 2004 Sep 1;101(5):1009-1017. In 295 cases, "Seropositivity for antibodies to HCV was associated with an odds ratio (OR) of 125 (95% confidence interval [95% CI], 17-909) for HCC, whereas seropositivity for antibodies to the hepatitis B core antigen was related to an OR of 2.9 (95% CI, 1.7-5.0). Heavy alcohol consumption and cigarette smoking were found to be independently associated with a statistically significant two to threefold increase in risk of HCC after adjustment for hepatitis B and C serology." This study is defective because of the large proportion of cases which are negative for HBV by serology, but positive by DNA.Yuan - Cancer 2004 abstract / PubMed
The effect of interaction between hepatitis C virus and cigarette smoking on the risk of hepatocellular carcinoma. Y Fujita, A Shibata, I Ogimoto, Y Kurozawa, T Nose, T Yoshimura, H Suzuki, N Iwai, R Sakata, S Ichikawa, A Tamakoshi. Br J Cancer 2006 Mar 13;94(5):737-739. This defective study considered only HCV infection and ignored HBV in order to lie that "The odds ratio of death from HCC for smoking was 9.60 (1.50-61.35) and 1.71(0.58-5.08) among anti-HCV positive and negative individuals, respectively."Fujita - Br J Cancer 2006 abstract / PubMed
Hepatitis viruses, alcohol, and tobacco in the etiology of hepatocellular carcinoma in Italy. S Franceschi, M Montella, J Polesel, C La Vecchia, A Crispo, L Dal Maso, P Casarin, F Izzo, LG Tommasi, I Chemin, C Trepo, M Crovatto, R Talamini. Cancer Epidemiol Biomarkers Prev 2006 Apr;15(4):683-689. "ORs for hepatitis B surface antigen (HBsAg) positive versus HBsAg negative and for anti-HCV antibody positive versus anti-HCV antibody negative were 20.2 and 15.6, respectively. Positivity for both markers was associated with an OR of 51.6... Tobacco smoking was unrelated to HCC risk overall but seemed to enhance HCC risk among virus carriers." In other words, they failed to find an increased risk from smoking despite using a study which is defective because it only evaluated HBsAg, but they attempted to chisel one out anyway.Franceschi - Cancer Epidemiol Biomarkers Prev 2006 abstract / PubMed
Alcohol, cofactors and the genetics of hepatocellular
Yu, JM Yuan, SC Lu. J Gastroenterol Hepatol 2008 Mar;23 Suppl 1:S92-97.
This study does not state which markers for HBV and HCV were used.
Supposedly, 109 were negative for HBV and/or HCV, versus 136 who were
positive, which is a suspiciously low rate of positivity. Funded by the
US National Institutes of Health.
Independent and additive interactive effects among tumor
factor-alpha polymorphisms, substance use habits, and chronic hepatitis
B and hepatitis C virus infection on risk for hepatocellular carcinoma.
JE Jeng, HR Tsai, LY Chuang, JF Tsai, ZY Lin, MY Hsieh, SC Chen, WL
Chuang, LY Wang, ML Yu, CY Dai, JG Chang. Medicine (Baltimore) 2009
Nov;88(6):349-357. Only serum hepatitis B surface antigen (HBsAg) and
antibodies to HCV (anti-HCV) were detected.
was Chairman of the IARC committee
which produced the fraudulent Monograph 83, as well as the Senior
Scientific Editor of
the 2004 Surgeon General report. He has been a ringleader in every
major anti-smoking offensive since the 1980s, including the Surgeon
General reports, the corrupt EPA
and committing perjury in the Minnesota and federal
"In the previous IARC Monograph on tobacco smoking, a causal
relation between liver cancer and smoking could not be established,
chiefly due to possible confounding from alcohol intake and hepatitis B
and hepaitis C viral infections. Many cohort studies and case-control
studies have provided additional information on smoking and liver
cancer since then. Most of the cohort studies and the case-control
studies (most notably those that included community controls) showed a
moderate association between tobacco smoking and risk of liver cancer.
In many studies, the risk for liver cancer increased with the duration
of smoking or the number cigarettes smoked daily. Former smokers who
had stopped smoking for more than 10 years showed a decline in liver
cancer risk. Confounding from alcohol can be ruled out, at least in the
best case-control studies, by means of careful adjustment for drinking
habits. An association with smoking has also been demonstrated among
non-drinkers. Many studies, most notably from Asia, have shown no
attenuation of the association between smoking and liver cancer after
adjustment/stratification for markers of hepatitis B/hepatitis C virus
infection. There is now sufficient evidence to judge the association
between tobacco smoking and liver cancer as causal."
Of the studies cited in this report to justify their pretense
smoking causes liver cancer, the majority had no information on HBV
(Hammond 1968; Basa 1977; Williams & Horn, 1977; Hirayama 1981;
Steinhagen 1983; Tu 1983; Yu 1983; Hardell 1984; Carstensen 1987; Kono
1987; La Vecchia 1988; Ferraroni 1989; Akiba & Hirayama 1990;
Hirayama 1990; Hsing 1990; Kew 1990; Olubuyide & Bamgboye 1990;
1990; Tsukuma 1990; Chen 1991; Lin 1991; Yu MC 1991; Kato 1992; Tanaka
1992; Doll 1994; Peters 1994; Pyong 1994; Goodman 1995; McLaughlin
1995; Siemiatycki 1995; Murata 1996;
Shin 1996; Yuan 1996; Chen 1997; Lam 1997; Nordlund 1997; Liu 1998;
Gao 1999; Lam 2001; Chen 2003; Mizoue 2000;
Lam 2001; Evans 2002; Chen 2003).
Of those which did, few evaluated any markers of HBV infection except HBsAg, which is insufficient (Trichopoulos 1980; Lam 1982; Tu 1985; Austin 1986; Hiyama 1990; Vall Mayans 1990; Choi & Kahyo 1991; Kato 1992, HBV ["Status known No adjustment No stratification"]; Mohamed 1992; Ross 1992; Tanaka 1995; Liaw & Chen 1998).
Only a few considered HCV as well as HBsAg (Tzonou 1991; Yu
& Chen 1993; London 1993, "no adjustment no stratification;"
Pyong 1994; Shin 1996; Mukaiya 1998; Sun 1999; Kuper 2000; Mori 2000;
Yang 2002). Peters 1994 included HBc, but the "controls" and 90% of
cases had cirrhosis. In Chiba 1996, all were HBsAg-negative patients
with HCV, evaluated for antibodies to HBsAg and HBc. Yu MW 1991
included HCV, HBsAg, and HBeAg.
The studies cited for adjustment and/or stratification for infection and smoking actually numbered only four (Yu MC 1991; Yu MW 1991; Liaw & Chen 1998; Kuper 2000). None of them was equal in quality to the at least seven studies appearing before 2001 which demonstrated the inadequacy of evaluating only HBsAg.
The abstract of the study by MC Yu made no mention of any such adjustments (Nonviral risk factors for hepatocellular carcinoma in a low-risk population, the non-Asians of Los Angeles County, California. Yu MC, Tong MJ, Govindarajan S, Henderson BE. J Natl Cancer Inst 1991 Dec 18;83(24):1820-1826).Yu MC / J Natl Cancer Inst 1991 abstract / PubMed
Association between hepatitis C virus antibodies and
carcinoma in Taiwan. MW Yu, SL You, AS Chang, SN Lu, YF Liaw, CJ Chen.
Cancer Res 1991 Oct 15;51(20):5621-5625. Multivariate-adjusted odds
ratio of 24.8 for carriers of HBsAg alone, 33.5 for carriers of both
HBsAg and HBeAg, and 23.7 for those who were positive for anti-HCV.
Note that these high odds ratios easily cause confounding from
undetected infection, and undetected infection is a certainty because
of their failure to look for all markers.
The only hepatitis virus infection marker mentioned in Liaw & Chen is hepatitis B virus surface antigen. (Mortality attributable to cigarette smoking in Taiwan: a 12-year follow-up study. KM Liaw, CJ Chen. Tob Control 1998 Summer;7(2):141-148.)Liaw & Chen / Tob Control 1998 full article
Tobacco smoking, alcohol consumption and their interaction in the causation of hepatocellular carcinoma. H Kuper, A Tzonou, E Kaklamani, CC Hsieh, P Lagiou, HO Adami, D Trichopoulos, SO Stuvor. Int J Cancer 2000 Feb 15;85(4):498-502). Note that co-author Dimitrios Trichopoulos is famed for his ETS studies. They tested sera only for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C, and triumphantly crowed that "We found a significant dose-response, positive association between smoking and HCC risk [>/= 2 packs per day, odds ratio (OR) = 2.5]. This association was stronger in individuals without chronic infection with either HBV or HCV (>/= 2 packs per day, OR = 2.8)."Kuper - Int J Cancer 2000 abstract / PubMed
And so their "many studies" which supposedly "have shown no attenuation of the association between smoking and liver cancer after adjustment/stratification for markers of hepatitis B/hepatitis C virus infection" may actually amount to only two.
The 2004 Surgeon General report used essentially the same body of inadequate and defective "evidence" as if their designs were of equal merit. They did not cite the smoking results of Chiesa 2000, nor discuss the other studies relating to occult HBV infection. "Evidence Synthesis: A substantial body of epidemiologic evidence supports a relationship between smoking and liver cancer, but a positive association was not found in all studies considered." [This obfuscates the fact that there is no substantial body of quality evidence supporting this claim.] "The metabolism in the liver of the many carcinogens from tobacco smoke leads to an exposure of hepatocytes to these carcinogens." [Which omits the fact that there are far more alleged carcinogens in ordinary food, and in higher quantities, e.g., benzo(a)pyrene.] "The strength of an association between cigarette smoking and liver cancer varies according to HBV infection status, with stronger associations among those who are negative for HBV." [Which is in fact an indicator of confounding, as explicitly confirmed by the studies of occult HBV they failed to discuss.] "In many of the studies, risk increases with the number of cigarettes smoked per day." [Which is a worthless point when the smoking results are confounded in the first place.] "Although confounding by alcohol and HBV infection status may bias the findings of some studies, controlling for these causes does not remove the strong association between smoking and liver cancer seen in several of the studies summarized in this report." [In all of the studies, evaluation of HBV infection is deficient, and the vast majority ignored HCV, so it cannot be pretended that they "controlled" in fact, as opposed to performing a statistical ritual.] "Finally, in 2002, IARC concluded that there is now sufficient evidence for a causal association between cigarette smoking and cancer of the liver (IARC 2002)." In other words, this politically-connected gang of charlatans made a big pile of junk studies to look impressive by the unexacting standards of anti-smoker politicians and the media.
The Surgeon General Reports are all deliberate, flagrant frauds, designed to manufacture bogus anti-smoking "evidence" for the health fascists' political agenda of outlawing smoking. Their despicable media prostitutes breathlessly announced that "The list of diseases linked to smoking grew longer Thursday" - as if this is a triumph instead of a disgrace! The scum triumphantly proclaimed that smoking causes a laundry list of diseases, including even ulcers and cervical cancer - all based on the deliberate fraud of confounding by infection! With regard to liver cancer, the vermin smarmily said that "current evidence is not conclusive enough to say smoking causes colorectal cancer, liver cancer, prostate cancer or erectile disfunction. Some research has associated those diseases with smoking, but Carmona said more proof is needed." To them, "proof" actually consists merely of saturation-bombing the people with BIG LIES repeated over and over again, just like the Nazis! (More Diseases Linked To Smoking. By Nancy Zuckerbrod. AP, May 27, 2004. CBS News HealthWatch.)More Diseases Linked To Smoking, May 27, 2004 / CBS News
Cigarette Smoking, Alcohol Drinking, Hepatitis B, and Risk for
Hepatocellular Carcinoma in Korea. SH Jee, H Ohrr, JW Sull, JM Samet. J
Natl Cancer Inst 2004 Dec 15;96(24):1851-1856. Jonathan
M. Samet is the
author in the "Herr Professor" position. Here, he
gloats that tobacco "was recently classified as causal by the
International Agency for Research on Cancer (IARC)," concerning
which they fail to note that Jonathan M. Samet himself was the chairman!
(List of Participants, p. 3. International Agency for Research on
Cancer (IARC). Tobacco smoke and involuntary smoking. IARC Monograph
83. Lyon, France: IARC; 2004.) "All participants reported their smoking
and alcohol consumption, and hepatitis B surface antigen (HBsAg) status
was documented for 47.2% of the participants... Current smoking was
associated with increased risk of mortality from hepatocellular
carcinoma in men (RR = 1.4; 95% CI = 1.3 to 1.6) but not women (RR =
1.1; CI = 0.8 to1.7). The relative risk of mortality from
hepatocellular carcinoma for male HBsAg carriers was 24.3 (95% CI =
21.9 to 26.9) times that in HBsAg-negative males; the relative risk for
HBsAg-positive women was 54.4 (95% CI = 24.8 to119.5)." They
fraudulently pretend that because the association with smoking didn't
change after performing adjustment rituals including stratification, it
demonstrates the absence of confounding, while ignoring hepatitis
Alcohol, tobacco and obesity are synergistic risk factors for
hepatocellular carcinoma (liver cancer). Jorge A. Marrero, Robert J.
Fontana, Sherry Fu, Hari S. Conjeevaram, Grace L. Su, Anna S. Lok.
Division of Gastroenterology, University of Michigan, 3912 Taubman
Center, Ann Arbor, MI 48109-0362, USA. Journal of Hepatology 2005
Feb;42(2):218-224. This study did not even consider the possibility
that hepatitis viruses of any kind cause liver cancer. It consisted of
nothing but a lifestyle questionnaire, upon the basis of which they
made specious proclamations that "alcohol, tobacco and obesity are
independent risk factors for HCC with a dose-dependent effect." The
study was approved by the University of Michigan Institutional Review
Cigarette smoking and liver cancer risk: an evaluation based
systematic review of epidemiologic evidence among Japanese. K Tanaka, I
Tsuji, K Wakai, C Nagata, T Mizoue, M Inoue, S Tsugane; Research Group
for the Development and Evaluation of Cancer Prevention Strategies in
Japan. Jpn J Clin Oncol 2006 Jul;36(7):445-456. They treat the issue of
occult infection as if it is of only trivial importance: "However,
potential confounding by chronic HBV and HCV infections was not
addressed in most studies. Since, in Japan, individuals with either or
both infections may have more than 100 times higher risk than those
without either (3,31), only a slight change in smoking habit among such
infected individuals could result in a substantial distortion of
associated RRs." This is false. It is not "change in smoking habits"
which causes confounding, it is a higher proportion of smokers among
those who are infected, which results also in a higher proportion of
smokers among those infection was not detected, which results in a
fraudulent claim of risk from smoking. "Chronic infections with both
HCV and HBV were taken into account in only three studies, all of which
followed patients with chronic liver disease" (which were Tsukuma 1993,
Chiba 1996, and Tanaka 1998). "In only two case–control studies, both
HCV and HBV infections were controlled for" (which were Mukaiya 1998
and Koide 2000). But these were in fact were NOT adequately controlled
for, because each of these studies missed a substantial proportion of
cases. Nevertheless, 12 cohort studies and 11 case-control studies were
thrown together regardless of their lack of quality, and a fraudulent
claim against smoking issued.
The contributions of hepatitis B virus and hepatitis C virus
infections to cirrhosis and primary liver cancer worldwide. JF Perz, GL
Armstrong, LA Farrington, YJ Hutin, BP Bell. J Hepatol 2006
Oct;45(4):529-538. They make the ridiculous claim that only 78% of HCC
was attributable to HBV (53%) or HCV (25%). They claim to have based
this upon "representative samples of published reports." Presumably
this means that they grabbed a handful of studies and averaged their
results, without regard to the quality of the work, as in the
Incompetent Meta-Analysis above. This exploits the multitude of trashy
studies which are funded to serve the political agenda of the
anti-smoking movement! And it contradicts the high-quality studies
which found a far greater role of HBV and HCV, including the study of
countries which found that markers of hepatitis viruses B and C were
not found in only about 5% of cases (Ding et al., Jpn J Infect Dis
2003). Obviously, the CDC has concocted a fraudulent estimate for
political purposes, in order
to "make room" to falsely blame smoking.
Effect of different types of smoking and synergism with
virus on risk of hepatocellular carcinoma in American men and women:
case-control study. MM Hassan,
MR Spitz, MB
Thomas, AS El-Deeb, KY Glover, NT Nguyen, W Chan, A Kaseb, SA Curley,
JN Vauthey, LM Ellis, E Abdalla, RD Lozano, YZ Patt, TD Brown, JL
Abbruzzese, D Li. Int J Cancer 2008 Oct 15;123(8):1883-1891. THERE IS
NO MENTION OF HBV IN THIS ACT OF FRAUD, which was funded by the
National Institutes of Health and the Texas Tobacco Settlement.
The Continuing Increase in the Incidence of Hepatocellular
in the United States: An Update. HB El-Serag, JA Davila, NJ Petersen,
KA McGlynn. Ann Intern Med 2003 Nov 18;139(10):817-823. In data from
the SEER registry, "The overall age-adjusted incidence rates of
hepatocellular carcinoma increased from 1.4 per 100 000 in 1975 to 1977
to 3.0 per 100 000 in 1996 to 1998. There was a 25% increase during the
last 3 years of the study compared with the preceding 3 years (1993 to
1995). The increase affected most age groups above 40 years, with the
greatest increase in the 45- to 49-year-old age group. White men had
the greatest increase (31%) in the last time period (1996 to 1998)
compared with 1993 to 1995. The Poisson regression model confirmed an
almost 2-fold increase in the incidence rate ratio for hepatocellular
carcinoma between 1975 to 1978 and 1996 to 1998... These findings are
consistent with a true increase and could be explained by consequences
of hepatitis C virus acquired during the 1960s and 1970s."
"A study from the Centers for Disease Control and Prevention
used mathematical modeling estimated that the HCV epidemic started in
the 1960s and peaked in the 1980s. Risk factors for transmitting HCV
were rampant during this period (for example, injection drug use,
needle sharing, and transfusion of unscreened blood and blood
products). A recent study examined the constant evolutionary rate of
HCV over time ("the molecular clock") in retrospectively collected
serum samples of HCV carriers in Japan and the United States. The study
concluded that HCV first appeared in Japan around 1882 and in the
United States around 1910, whereas widespread dissemination occurred in
the 1930s in Japan and in the 1960s in the United States. These
findings suggest that hepatocellular carcinoma in the United States
will continue to increase for the near future. Currently, the highest
prevalence HCV infection rate is among 40- to 50-year-old persons who
have been infected for 1 to 2 decades and are expected to live for
another 2 to 3 decades with the increased potential for developing
Hepatocellular Carcinoma Incidence, Mortality, and Survival
in the United States From 1975 to 2005. SF Altekruse, KA McGlynn, ME
Reichman. J Clin Oncol 2009 Mar 20;27(9):1485-1491. From the
Surveillance, Epidemiology, and End Results (SEER) registries from 1975
to 2005. "Age-adjusted HCC incidence rates tripled between 1975 and
2005. Incidence rates increased in each 10-year birth cohort from 1900
through the 1950s," especially among men.
Aging of hepatitis C virus (HCV)-infected persons in the
States: a multiple cohort model of HCV prevalence and disease
progression. GL Davis, MJ Alter, H El-Serag, T Poynard, LW Jennings.
Gastroenterology 2010 Feb;138(2):513-521. "Hepatic decompensation and
liver cancer will continue to increase for another 10 to 13 years.
Treatment of all infected patients in 2010 could reduce risk of
cirrhosis, decompensation, cancer, and liver-related deaths by 16%,
42%, 31%, and 36% by 2020, given current response rates to antiviral
Hepatocellular Carcinoma --- United States, 2001--2006. MMWR
May 7;59(17):517-520. "[T]he average annual incidence rate of HCC for
2001--2006 was 3.0 per 100,000 persons and increased significantly from
2.7 per 100,000 persons in 2001 to 3.2 in 2006, with an average annual
percentage change in incidence rate (APC) of 3.5%. The largest
increases in HCC incidence rates were among whites (APC = 3.8), blacks
(APC = 4.8), and persons aged 50--59 years (APC = 9.1). "
Hopefully, better testing will be done in clinical practice as well. "Liver transplanted from HBsAg-negative donors can harbor and transmit hepatitis B infection to recipients, according to a report in the December Journal of Medical Virology. Previous studies have suggested the possibility of transmission of hepatitis B from liver donor to recipient despite the absence of HBV viremia in the donor, the authors explain, but no genetic analysis has been conducted to confirm these cases." (Orthotopic liver transplantation transmits hepatitis B. Medscape - Reuters Medical News 2000 Dec 20 http://id.medscape.com/31574.rhtml link died); De novo infection of hepatitis B in patients with orthotopic liver transplantation: analysis by determining complete sequence of the genome. A Rokuhara, E Tanaka, S Yagi, H Mizokami, Y Hashikura, S Kawasaki, K Kiyosawa. J Med Virol 2000 Dec;62(4):62(4):471-478.)Rokuhara - J Med Virol 2000 abstract / PubMed
Liver transplantation in hepatitis B core-negative recipients using livers from hepatitis B core-positive donors: A 13-year experience. HE Bohorquez, AJ Cohen, N Girgrah, DS Bruce, IC Carmody, S Joshi, TW Reichman, G Therapondos, AL Mason, GE Loss. Liver Transpl 2013 Jun;19(6):611-618. "Sixty-four HBsAg(-) /HBcAb(-) patients (6.3%) received an HBsAg(-) /HBcAb(+) liver. All donor sera were negative for HBcAb immunoglobulin M and HBV DNA." After mean follow-up of 48.8 months, "Nine of the 64 patients (14.1%) developed de novo HBV. The mean time from LT to de novo HBV was 21.4 ± 26.1 months..."Bohorquez - Liver Transpl 2013 abstract / PubMed
Hepatitis B virus genotypes in the United States: results of a nationwide study. CJ Chu, EB Keeffe, SH Han, RP Perrillo, AD Min, C Soldevila-Pico, W Carey, RS Brown Jr., VA Luketic, N Terrault, AS Lok. Gastroenterology 2003 Aug;125(2):444-451. "The prevalence of HBV genotypes was different in different regions of the United States. A strong correlation was found between HBV genotypes and ethnicity..."Chu - Gastroenterology 2003 / PubMed abstract
Novel hepatitis B virus genotype A subtyping assay that distinguishes subtype Aa from Ae and its application in epidemiological studies. I Hasegawa, Y Tanaka, A Kramvis, T Kato, F Sugauchi, SK Acharya, E Orito, R Ueda, MC Kew, M Mizokami. J Virol 2004 July;78(14):7575-7581. African-Americans, Caucasians and Hispanics had HBV/Ae, whereas Asians had mainly HBV/Aa, "suggesting that the HBV/Aa isolates may have been imported by recent immigration from Asia."Hasegawa / J Virol 2004 Full Article
Hepatitis C Virus Genotypes in Clinical Specimens Tested at a
National Reference Testing Laboratory in the United States. JJ Germer,
JN Mandrekar, JL Bendel, PS Mitchell, JD Yao. J Clin Microbiol 2011
Aug;49(8):3040-3043. "Hepatitis C virus (HCV) genotype (GT)
distribution and frequency were studied among 22,407 unique specimens
tested at a national reference testing laboratory. Subjects with HCV GT
3 were younger (P<0.0001) than those with GT 1, 2, or 4, and
regional frequency of HCV GT 2/3 ranged from 19.9% to 29.2%."
Hepatitis C virus genotype distribution varies by underlying
status among patients in the same geographic region: A retrospective
multicenter study. HA Torres, MI Nevah, BJ Barnett, P Mahale, DP
Kontoyiannis, MM Hassan, II Raad. J Clin Virol 2012 Jul;54(3):218-222.
"We included 129 cancer patients (53 with hematologic
malignancies and 76 with solid tumors), 333 immunocompetent patients,
and 102 HIV-co-infected patients. The prevalence of genotype 1 (G-1)
was 66% among cancer patients, 84% among immunocompetents (P=0.00004),
and 99% among HIV-co-infected patients (P<0.00001). G-2 and G-3
more common in cancer patients than other patients. Demographics, risk
factors, and duration of HCV infection were similar between cancer and
immunocompetent patients. G-1 was more prevalent in immunocompetents
(84%) than in patients with hepatocellular carcinoma (74%, P=0.08) or
lymphoma (59%, P=0.001). G-2 was more prevalent in lymphoma patients
(24%) than in immunocompetents (8%, P=0.003); cancer risk was 3 times
as great with G-2 as with other genotypes (OR 3.72, 95% CI 1.38-9.76)."
Hepatitis B virus genotypes: Global distribution and clinical importance. M Sunbul. World J Gastroenterol 2014 May 14;20(18):5427-5434. "To date, 10 HBV genotypes, scattered across different geographical regions, have been identified. For example, genotype A has a tendency for chronicity, whereas viral mutations are frequently encountered in genotype C. Both chronicity and mutation frequency are common in genotype D. LC and progression to HCC are more commonly encountered with genotypes C and D than the other genotypes."Sunbul - World J Gastroenterol 2014 full article / PubMed Central
Enigmatic origin of hepatitis B virus: An ancient travelling companion or a recent encounter? G Zehender, E Ebranati, E Gabanelli, C Sorrentino, A Lo Presti, E Tanzi, M Ciccozzi, M Galli. World J Gastroenterol 2014 Jun 28;20(24):7622-7634. "Genotypes A and D are ubiquitous and the most prevalent genotypes in Europe (mainly represented by subgenotypes D1-3 and A2); genotypes B and C are restricted to eastern Asia and Oceania; genotype E to central and western Africa; and genotypes H and F (classified into 4 subgenotypes) to Latin America and Alaska."Zehender - World J Gastroenterol 2014 full article / PubMed
Hepatitis B virus has been accepted as a cause of liver cancer for decades. However, because it has not been found to cause any distinctive mutation(s), it has been thought that HBV did so purely as a result of the increased proliferation of liver cells resulting from their destruction by the virus.
But evidence is building that the X protein of HBV may cause cancer by interfering with the cellular repair mechanisms under the control of the crucial p53 tumor suppressor protein, much as the E6 protein of human papillomavirus is known to do.
1) Early in the process of cell repair and division, p53 activates the cellular genes WAF1 (also called p21) and GADD45.
2) WAF1 protein inhibits cyclin dependent kinases (cdks), which prevents them from phosphorylating the Rb protein. The unphosphorylated Rb keeps the cell arrested at the G1 stage.
3) GADD45 repairs damaged DNA. When the DNA has been repaired, p53 levels decline, which lowers the WAF1 levels and releases the cdks, which phosphorylate the Rb so the cell is free to progress from the G1 to the S stage. Alternatively, if the DNA is not repaired, p53 causes the cell to die (apoptosis).
4) The activity of p53 is blocked, however, if cells contain the polyoma virus large T antigen, human papillomavirus E6 protein, or adenovirus E1B 55KD protein. Now, there is evidence that the X protein of HBV (HBx) binds to p53 in the cytoplasm, which prevents it from entering the nucleus and causing the death of the cell if the DNA has not been repaired.
Mutations occur during practically every cell division. High levels of p53 occur after widespread cell damage such as caused by ultraviolet light. So, these viruses can cause cancer by interfering with the normal protective mechanisms that guard against mutations.
Hepatitis B virus X protein and p53 tumor suppressor interactions in the modulation of apoptosis. LW Elmore, AR Hancock, S-F Chang, XW Wang, S Chang, CP Callahan, DA Geller, H Will, CC Harris. Proc Natl Acad Sci USA 1997 Dec;94(26):14707-14712.Elmore / PNAS 1997 full article
Hepatitis B virus X protein interferes with cellular DNA repair. SA Becker, T-H Lee, JS Butel, BL Slagle. J Virol 1998 Jan;72(1):266-272.Becker / J Virol 1998 full article
Hepatitis viruses: their role in human cancer. DW Bradley. Proc Assoc Am Physicians 1999 Nov-Dec;111(6):588-593.Bradley - Proc Assoc Am Physicians 1999 abstract / PubMed
Involvement of Crm1 in hepatitis B virus X protein-induced
centriole replication and abnormal mitotic spindles. M Forgues, MJ
Difilippantonio, SP Linke, T Ried, K Nagashima, J Feden, K Valerie, K
Fukasawa, XW Wang. Mol Cell Biol 2003 Aug;23(15):5282-5292. "Hepatitis
B virus (HBV) includes an X gene (HBx gene) that plays a critical role
in liver carcinogenesis. Because centrosome abnormalities are
associated with genomic instability in most human cancer cells, we
examined the effect of HBx on centrosomes. We found that HBx induced
supernumerary centrosomes and multipolar spindles. This effect was
independent of mutations in the p21 gene. Furthermore, the ability of
HBV to induce supernumerary centrosomes was dependent on the presence
of physiological HBx expression."
Pathogenesis of hepatitis B virus-related hepatocellular
old and new paradigms. C Brechot. Gastroenterology. 2004 Nov;127(5
Suppl 1):S56-S61. "Chronic infection with the hepatitis B virus (HBV)
is a major risk factor for development of hepatocellular carcinoma
(HCC). The pathogenesis of cancer in HBV infection has been extensively
analyzed, and multiple factors appear to play a role. A major factor is
chronic inflammation and the effects of cytokines in the development of
fibrosis and liver cell proliferation. Also important is the role of
integration of HBV DNA into host cellular DNA, which, in some
situations, acts to disrupt or promote expression of cellular genes
that are important in cell growth and differentiation. In addition,
expression of HBV proteins may have a direct effect on cellular
functions, and some of these gene products can favor malignant
transformation. Several HBV genes have been found in infected tissues
more frequently than others, including truncated pre-S2/S, hepatitis B
X gene, and a novel spliced transcript of HBV, referred to as the
hepatitis B spliced protein. The proteins expressed from these
integrated genes have been shown to have intracellular activities that
may account for their association with HCC, including effects on
cellular growth and apoptosis. Finally, some patients with HCC have no
detectable hepatitis B surface antigen in serum but do have low levels
of HBV DNA in serum and integrated molecules of HBV DNA in tissue.
Occult HBV infection may account for a proportion of cases of HCC that
occur in patients without serologic markers for hepatitis B and C and
may be a cofactor in HCC in patients with chronic hepatitis C who have
coexistent occult HBV infection."
Specific mutations of hepatitis B virus in plasma predict
cancer development. Kuang SY, Jackson PE, Wang JB, Lu PX, Munoz A, Qian
GS, Kensler TW, Groopman JD. Proc Natl Acad Sci U S A 2004 Mar
9;101(10):3575-3580. 74% of liver carcinomas were positive for a 1762T/1764A
mutation of HBV. "67 of 70 (95.7%) tumors contained detectable levels
of either the HBV double mutation or integrated WT HBV DNA or both.
Fifty-two of the specimens (74.3%) contained the 1762T/1764A HBV
mutation." In over 53% of cases from a prospective study, the mutation
was found in plasma samples up to eight years before diagnosis.
Association of p16INK4A hypermethylation with hepatitis B
protein expression in the early stage of HBV-associated
hepatocarcinogenesis. R Zhu, BZ Li, H Li, YQ Ling, XQ Hu, WR Zhai, HG
Zhu. Pathol Int 2007 Jun;57(6):328-36. "The data indicate that
p16(INK4A) promoter hypermethylation correlated closely with higher HBx
expression in the precancerous lesions, suggesting that HBx may play an
important role in the early stage of HBV-associated
hepatocarcinogenesis via induction of hypermethylation of p16(INK4A)
Regulation of hepatitis B virus replication by the
phosphatidylinositol 3-kinase-akt signal transduction pathway. H Guo, T
Zhou, D Jiang, A Cuconati, GH Xiao, TM Block, JT Guo. J Virol 2007
Sep;81(18):10072-10080. "Consistent with previous reports showing that
the HCV NS5A protein could bind to the p85 subunit of PI3K and activate
the PI3K-Akt signal transduction pathway, our results showed that
expression of this protein could inhibit HBV RNA transcription and
reduce HBV DNA replication in HepG2 cells. Taken together, our results
suggest that the activation of the PI3K-Akt pathway during liver
oncogenesis may be at least partially responsible for the elimination
of HBV replication from tumor cells and may also provide an explanation
for the observed suppression of HBV replication by HCV coinfection."
Role of hepatitis B virus X repression of C/EBPbeta activity in the down-regulation of glutathione S-transferase A2 gene: implications in other phase II detoxifying enzyme expression. IJ Cho, SH Ki, C Brooks 3rd, SG Kim. Xenobiotica 2009 Feb;39(2):182-192. "[C]hromatin immunoprecipitation assays confirmed HBx inhibition of C/EBPbeta binding to its binding site in the GSTA2 gene promoter. HBx repressed the induction of other phase II enzymes including GSTP, UDP-glucuronyltransferase 1A, microsomal epoxide hydrolase, GSTM1, GSTM2, and gamma-glutamylcysteine synthase. 5. These results demonstrate that HBx inhibits the induction of phase II detoxifying enzymes, which is mediated by its interaction with C/EBPbeta, but not Nrf2, substantiating the specific role of HBx in phase II detoxifying capacity."Cho - Xenobiotica 2009 abstract / PubMed
The Size of the Viral Inoculum Contributes to the Outcome of
Hepatitis B Virus Infection. S Asabe, SF Wieland, PK Chattopadhyay, M
Roederer, RE Engle, RH Purcell, FV Chisari. J Virol 2009
Oct;83(19):9652-9662. Both high-dose and low-dose inocula allowed
infection of 100% of hepatocytes resulting in prolonged immunopathology
before clearance occurred. In contrast, intermediate nocula primed the
T-cell response before detectable logarithmic spread and were abruptly
terminated with minimal immunopathology before 0.1% of hepatocytes were
Hepatitis B Viral Replication Induces Methylation of Both Host
Viral DNA. P Vivekanandan, HD Daniel, R Kannangai, F Martinez-Murillo,
M Torbenson. J Virol 2010 May;84(9):4321-4329. "[H]epatocytes respond
to HBV infection by up-regulating DNMTs. The DNMTs methylate viral DNA
leading to decreased viral gene expression and decreased viral
replication. However, viral induced over expression of DNMTs also leads
to methylation of host CpG islands."
Epigenetic repression of E-cadherin expression by hepatitis B virus x antigen in liver cancer. A Arzumanyan, T Friedman, E Kotei, IO Ng, Z Lian, MA Feitelson. Oncogene 2012 Feb 2;31(5):563-572. "Loss of E-cadherin is associated with acquisition of metastatic capacity. Numerous studies suggest that histone deacetylation and/or hypermethylation of CpG islands in E-cadherin gene (CDH1) are major mechanisms responsible for E-cadherin silencing in different tumors and cancer cell lines... In HepG2X cells, decreased levels of E-cadherin and elevated levels of mSin3A and Snail-1 were detected. Reciprocal IP with anti-HBx and anti-mSin3A demonstrated mutual binding. Furthermore, HBx-mSin3A colocalization was detected by immunofluorescent staining. HBx downregulated E-cadherin expression by the recruitment of the mSin3A/histone deacetylase complex to the Snail-binding sites in human CDH1. Histone deacetylation inhibition by Trichostatin-A treatment restored E-cadherin expression. Mir-373, a positive regulator of E-cadherin expression, was downregulated by HBx in HepG2X cells and tissue sections from HBV-infected patients."Arzumanyan - Oncogene 2012 full article / PubMed Central
Molecular Mechanisms of HBV-Associated Hepatocarcinogenesis. F Guerrieri, L Belloni, N Pediconi, M Levrero. Semin Liver Dis 2013 May;33(2):147-156. Review.Guerrieri - Semin Liver Dis 2013 abstract / PubMed
Role of hepatitis B virus genotype D & its mutants in occult hepatitis B infection. S Sengupta, SK Panda, SK Acharya, H Durgapal. Indian J Med Res 2013 Sep;138(3):329-339. "Genotype D of HBV has a characteristic 33 nucleotide (nt) deletion upstream of the pre-S2/S promoter. This deletion may reduce HBsAg secretion in occult infection patients infected with genotype D HBV... Genotype D replicon showed a decrease in HBsAg secretion compared to the wild-type genotype A. Genotype D replicons carrying additional pre-S2/S promoter deletions, showed further reduction in HBsAg secretion, demonstrated presence of intracellular HBcAg/HBeAg, virus replication intermediates and 'e' antigen secretion... Pre-S2/S promoter deletions do not affect HBV replication."Sengupta - Indian J Med Res 2013 abstract / PubMed
Hepatitis B virus core protein interacts with CD59 to promote complement-mediated liver inflammation during chronic hepatitis B virus infection. D Liu, B Ni, L Wang, M Zhang, W Liu, Y Wu. FEBS Lett 2013 Oct 11;587(20):3314-3320. "The expression of CD59 was markedly down-regulated in HBc-transfected HepG2 or HepG2.215 cells, which resulted in an upshift of hepatocyte sensitivity to membrane attack complex (MAC)-induced cell lysis. These results were consistent with the accumulation of MACs in the liver of HBV-infected patients."Liu - FEBS Lett 2013 abstract / PubMed
Hepatitis C virus core protein promotes immortalization of
human hepatocytes. RB Ray, K Meyer, R Ray. Virology 2000 May
25;271(1):197-204. Core-transfected primary human hepatocytes displayed
altered cell morphology resembling that of low-differentiated
epithelial cells. Those cells retained an immortalized phenotype and
exhibited continuous growth after more than 50 passages over 2 years.
Stable hepatocyte transfectants exhibited albumin secretion and HCV
core protein expression. Telomerase activity, a characteristic of
immortalized or transformed cells, was evident in the transfected
hepatocytes immediately after senescence. Anchorage-independent growth
of the immortalized hepatocytes provided further evidence for a
transformed phenotype. Results from these studies suggest that the HCV
core protein promotes primary human hepatocytes to an immortalized
phenotype, which may predispose cells over an extended period of time
to undergo a transforming event. Thus, HCV core protein appears to
contribute to virus-mediated pathogenesis in a persistently infected
Molecular cytogentic profiles of hepatitis C infection in
at Sharkia Governorate, Egypt. E el-Sobky, AM Mangoud, S Mahrous, MH
Eissa, EI Sabee, IA Ibrahem, A Ismail, TA Morsy, E Nor Edin, I
el-Naggar, Y Mostafa, Y Abuel-Magd, AF Afefy, E el-Shorbagy, M
el-Sadawy, H Ragab, A el-Far, MI Hassan, K Lakouz, K Abdel-Aziz M
Saber, G el-Hady. J Egypt Soc Parasitol 2004 Apr;34(1 Suppl):401-415.
40 paraffin blocks from HBV-seronegative, HCV-positive patients, by
FISH. "The results showed high percentage of S-phase fraction in cases
of G2S2 and G3S3 with DNA diploidy. Only two cases of G3S3 showed DNA
aneuploidy with severe amplification of chromosome 20q 13.2." HCV
amplifies the aggressive tumor behavior oncogene LSIZNF 217 at
chromosome 20q 13.2.
Hepatitis C virus core protein inhibits tumor suppressor
promyelocytic leukemia function in human hepatoma cells. K Herzer, S
Weyer, PH Krammer, PR Galle, TG Hofmann. Cancer Res 2005 Dec
1;65(23):10830-10837. "Importantly, we show that HCV core protein
inhibits PML-IV-induced apoptosis and interferes with the coactivator
function of PML-IV for proapoptotic p53 target genes including CD95
(Fas/APO-1). In particular, we found that the HCV core inhibits
p53-mediated target gene expression by predominantly targeting the
coactivator function of PML-IV because HCV core-mediated p53 target
gene repression was absent in PML-ablated cells. HCV core expression
abrogated both p53 serine 15 phosphorylation and lysine 382
acetylation, two p53-activating posttranslational modifications which
were previously linked to an increased PML-NB formation. Taken
together, our results suggest a potential mechanism for HCV-associated
development of hepatocellular carcinoma through HCV core-mediated
inactivation of the PML tumor suppressor pathway."
Hepatitis C Virus Induces E6AP-Dependent Degradation of the
Retinoblastoma Protein. T Munakata, Y Liang, DR McGivern, J Huibregtse,
A Nomoto, SM Lemon. PLoS Pathogens 2007;3(9):e139. "Persons infected
with hepatitis C virus (HCV) are at increased risk for liver cancer.
This is remarkable because HCV is an RNA virus with replication
confined to the cytoplasm and no potential for integration of its
genome into host cell DNA. While it is likely that chronic inflammation
contributes to liver cancer, prior studies with HCV transgenic mice
indicate that the viral proteins are intrinsically carcinogenic. In
this study, we have examined the interaction of one of these, the
RNA-dependent RNA polymerase nonstructural protein 5B, with an
important cellular tumor suppressor protein, the retinoblastoma protein
(pRb). pRb is a master regulator of the cell cycle, and altered
expression of some of the many genes it regulates may lead to cancer.
We show that the abundance of pRb is strongly downregulated in cells
infected with HCV, and that nonstructural protein 5B targets pRb for
destruction via the cell's normal protein degradation machinery. The
E6-associated protein appears to play a role in this process, which is
interesting as it also mediates the degradation of another tumor
suppressor, p53, by papillomaviruses. The loss of pRb function in
HCV-infected cells likely promotes hepatocellular proliferation as well
chromosomal instability, factors important for the development of liver
Hepatitis C virus core protein downregulates E-cadherin
via activation of DNA methyltransferase 1 and 3b. P Arora, EO Kim, JK
Jung, KL Jang. Cancer Lett 2008 Mar 18;261(2):244-252. "Here, we report
that hepatitis C virus Core downregulates E-cadherin expression at the
transcription level. This effect was abolished after treatment of
5'-Aza-2'dC, a specific inhibitor of DNA methyltransferase (DNMT). In
addition, this repression was strongly correlated with hypermethylation
of CpG islands of E-cadherin promoter via concerted action of both
DNMT1 and 3b in Core-expressing cells. The decreased E-cadherin
expression results in dramatic morphological changes in Core-expressing
cells. In addition, Core-expressing cells aggregate poorly in
suspension culture, reflecting their altered cell-cell interactions.
The biological significance was further demonstrated by the increased
collagen invasion ability of Core-expressing cells."
Hepatitis C Virus Causes Uncoupling of Mitotic Checkpoint and
Chromosomal Polyploidy through the Rb Pathway. K Machida, JC Liu, G
McNamara, A Levine, L Duan, MM Lai. J Virol 2009
Dec;83(23):12590-12600. "[P]eripheral blood mononuclear cells (PBMC)
hepatitis C patients and hepatocytes infected with HCV in vitro showed
frequent chromosomal polyploidy. HCV infection or the expression of
viral core protein alone in hepatocyte culture or transgenic mice
inhibited mitotic spindle checkpoint function because of reduced Rb
transcription, and enhanced E2F-1 and Mad2 expression."
Hepatitis C virus inhibits DNA damage repair through reactive
and nitrogen species and by interfering with the ATM-NBS1/Mre11/Rad50
DNA repair pathway in monocytes and hepatocytes. K Machida, G McNamara,
KT Cheng, J Huang, CH Wang, L Comai, JH Ou, MM Lai. J Immunol 2010 Dec
1;185(11):6985-6998. "The viral core and nonstructural protein 3
proteins were shown to be responsible for the inhibition of DNA repair,
mediated by NO and reactive oxygen species. Stable expression of core
protein induced frequent chromosome translocations in cultured cells
and in transgenic mice. HCV core protein binds to the NBS1 protein and
inhibits the formation of the Mre11/NBS1/Rad50 complex, thereby
affecting ATM activation and inhibiting DNA binding of repair enzymes."
Core antigen tests for hepatitis C virus: a meta-analysis. S Gu, J Liu, H Zhang, B Gu, H Lai, H Zhou, C He, Y Chen. Mol Biol Rep 2012 Aug;39(8):8197-8208. "Diagnosis and monitoring of hepatitis C virus (HCV) infection relies mainly on the detection of HCV antibodies and HCV RNA. HCV antibody test has a longer window period and is not applicable in the immunosuppressed population. Although HCV RNA test reduces the window period, it is still not widely recommended because of its high cost and requirement of specific equipment. HCV core antigen is another direct virological marker which has been investigated in recent years. HCV core antigen assay is as simple as the HCV antibodies assay and can detect HCV infection only 1 day delay compared to the HCV RNA assay... The pooled sensitivity of HCV core antigen assay was 0.84 (95 % CI, 0.83-0.85), and the pooled specificity was 0.98 (95 % CI, 0.97-0.98). HCV core antigen assays may not displace HCV RNA assays to be a definitive diagnosis of HCV infection until now. Considering the higher sensitivity (0.926) and specificity (0.991) of subgroup, HCV-cAg detection is a promising method as a confirmatory test for HCV antibody positive, therapy-naive individuals."Gu - Mol Biol Rep 2012 abstract / PubMed
Hepatitis C virus-induced activation of β-catenin promotes c-Myc expression and a cascade of pro-carcinogenetic events. MR Higgs, H Lerat, JM Pawlotsky. Oncogene 2013 Sep 26;32(39):4683-4693. "Mechanistically, activation of Akt by the HCV non-structural protein NS5A, and the subsequent stabilization of the transcription factor β-catenin, was demonstrated to be responsible for activation of the c-Myc promoter, and for increased c-Myc transcription. β-Catenin-dependent c-Myc expression in this context led to increased production of reactive oxygen species, mitochondrial perturbation, enhanced DNA damage and aberrant cell-cycle arrest."Higgs - Oncogene 2013 abstract / PubMed
HCV core-mediated activation of latent TGF-β via thrombospondin drives the cross-talk between hepatocytes and stromal environment. N Benzoubir, C Lejamtel, S Battaglia, B Testoni, B Benassi, C Gondeau, L Perrin-Cocon, C Desterke, V Thiers, D Samuel, M Levrero, C Bréchot, MF Bourgeade. J Hepatol 2013 Dec;59(6):1160-1168. "Active TGF-β levels were increased in HCV core transgenic mice livers. Overexpression of core protein in hepatoma cells increased active TGF-β levels in culture supernatants and induced Smad2/3 phosphorylation, thus reflecting activation of the TGF-β signaling pathway. Moreover, our data showed the implication of shrombospondin-1 in core-dependent TGF-β activation. Finally, hepatoma cells expressing HCV core could activate stellate cells in co-culture and this activation was TGF-β dependent."Benzoubir - J Hepatol 2013 abstract / PubMed
Quantitative detection of hepadnavirus-infected lymphoid cells by in situ PCR combined with flow cytometry: implications for the study of occult virus persistence. PM Mulroney, TM Michalak. J Virol 2003 Jan;77(2):970-979. "The detection of small amounts of viral pathogens in infected cells by classical PCR is hampered by a partial loss of virus nucleic acid due to extraction and by difficulties in discriminating between truly intracellular virus genome material and that possibly adhered to the cell surface... In this study, hepadnavirus-specific in situ PCR combined with the enzymatic elimination of extracellular virus and flow cytometry permitted detection of viral genomes in lymphoid cells without nucleic acid isolation and allowed quantification of infected cells during the course of persistent infection with woodchuck hepatitis virus (WHV)... The data obtained provide further evidence that WHV infection continues indefinitely in the lymphatic system independently of whether it is symptomatic or concealed."Mulrooney / J Virol 2003 Full Article
Detection of hepatitis B and C viruses in almost all
modified PCR-based in situ hybridization. H Nuriya, K Inoue, T Tanaka,
Y Hayashi, T Hishima, N Funata, K Kaji, S Hayashi, S Kaneko, M Kohara.
J Clin Microbiol 2010 Nov;48(11):3843-3851. "HBV-genomic DNA
was detected in almost all hepatocytes, whereas HBV-RNA or protein was
differentially distributed only in a subset of the HBV-DNA-positive
region. Further, HCV-genomic RNA was detected in almost all hepatocytes
and was localized to the cytoplasm. HCV-RNA was also detected in the
epithelium of the large bile duct but not in endothelial cells, portal
tracts, or sinusoidal lymphocytes. In patients with HBV and HCV
coinfection, HCV-RNA was localized to the noncancerous tissue whereas
HBV-DNA was found only in the cancerous tissue. Using this novel
PCR-ISH method, we could visualize the staining pattern of HBV and HCV
in liver sections, and obtained results consistent with those of
real-time detection (RTD)-PCR analysis. In conclusion, almost all
hepatocytes are infected with HBV or HCV in chronic liver disease; this
finding implies that the viruses spreads throughout the liver in the
New perspectives in occult hepatitis C virus infection. V
Bartolomé, I Castillo, JA Quiroga. World J Gastroenterol 2012 Jun
The reliability of HBV core antibody in serological screening for hepatitis B virus. F Ba Alawi, PW Robertson, AK Lepage, J Jayamaha, C Baleriola, WD Rawlinson. 2013 Aug;45(5):501-505. 2778 blood samples assessed for HBV DNA, of which 331 had serology testing as well. "Positive HBcAb in the absence of HBV DNA was found in 67 of 331 (20.2%) patients. Of these, 18 of 67 had isolated HBcAb with negative results on all other tests, with 12 of 18 (3.6%) demonstrating low HBcAb signals on chemiluminscent microparticle assay. No cases of detectable HBV DNA in the presence of negative serology were found."Ba Alawi - Pathology 2013 abstract / PubMed
Necessity for reassessment of patients with serogroup 2 hepatitis C virus (HCV) and undetectable serum HCV RNA. Y Moritou, F Ikeda, Y Takeuchi, H Seki, S Nanba, Y Iwasaki, K Yamamoto. J Clin Microbiol 2014 Feb;52(2):544-548. "Among the 891 anti-HCV-positive patients, 4 patients had serum HCV RNA levels that were undetectable by CAP/CTM version 1 despite having levels of >5 log IU/ml that were detected by ART. All four patients had HCV genotype 2a and high titers of anti-HCV." Variant HCV nucleotides caused this problem, which was corrected in version 2.Moritou - J Clin Microbiol 2014 abstract / PubMed