Impact of occult HBV infection in HCC presentation in HCV-related cirrhosis

Introduction: The role of the occult HBV infection (OBI) as an additional risk factor for hepatocellular carcinoma (HCC) has not been fully investigated. Aims: To evaluate the impact of OBI (HBV DNA in liver tissue in HBsAg negative patients) in the clinical presentation of HCC in subjects with HCV-related cirrhosis. Methods and results: 46 consecutive patients with HCC were enrolled at two centers from June 2013 to April 2014: 7 HBsAg positive (positive control group; 6 males, mean age 68±1.53 years); 7 HBsAg/anti-HBc/anti-HCV negative (negative control group; all males, mean age 68±1.41 years); 32 anti-HCV positive and HBsAg negative (Case group; 19 males, mean age 71±5.9 years; 16 positive for anti-HBc and 16 negative). Of these 16 anti-HBc positive patients, 9 were anti-HBs/antiHBc positive and 7 anti-HBs negative/antiHBc positive. For each patient a sample of plasma and HCC-liver tissue were collected. The liver HBV DNA was identified by real-time PCR and quantified in relation to DNA -globin. The 7 positive controls were all positive for HBV-DNA in liver (range 7.5×102 to 5.8×105 IU/cells), while all the 7 negative controls negative. In the case group, liver HBV-DNA was positive in 6 (37.5%) of 16 anti-HBc positive patients (range: 1.8×101 IU/cells to 4.06×103 IU/cells) and only in 1 of 16 anti-HBc negative (2.16×102 IU/cells). All the 6 anti-HBc positive patients with positivity for HBV-DNA in liver tissue were anti-HBs negative. The demographic (sex, age, BMI), biochemical (AST/ALT/ALP/total bilirubin/ FP/albumin/PLT/PT) and clinical (unifocal or multifocal HCC, diameter of HCC, HCC localization) were similar in the 7 patients with occult HBV infection and in the 25 without. Conclusions: OBI was found in 22% of the patients with HCVrelatedHCC; it is rare (1/25) in subjects anti-HBs/anti-HBc negative and frequent (37.5%) in those anti-HBcpositive, particularly (85.7%) in those with isolated anti-HBc, without impact on the clinical presentation of HCC.