Occult hepatitis B infection: a hidden factor of poor response to intervention treatment of hepatocellular carcinoma in chronic hepatitis C patients

Hepatocellular carcinoma (HCC), a tumor associated with high mortality, has rising worldwide incidence. Occult hepatitis B (OBI) could influence the development of HCC with a strong association with HCV infection. The risk of tumor recurrence or poor response to treatment may be due to the presence of underlying cirrhosis with viral hepatitis. The aim of this study is to assess the prevalence of OBI among patients who are hepatitis B core antibody positive with chronic hepatitis C (CHC) having HCC and assess its impact on treatment response. A total of 240 patients with CHC who were negative for hepatitis B surface antigen (HBsAg) were enrolled. One hundred twenty patients were diagnosed to have HCC for which they underwent interventional treatment whereas 120 patients had no evidence of HCC. Hematological and biochemical tests, Anti-HBc IgG, and HBV-DNA were done. Prevalence of isolated Anti-HBc IgG and HBV DNA in their sera were 70 and 23.8% respectively in HCC patients, but only 43.3% and 15.4% respectively in CHC patients. Patients who tested positive for anti-HBc IgG had one and half times higher risk of having HCC when compared patients who tested negative. Majority (84.6%) of patients with HCC who were non-responders to interventional treatment tested positive for anti-HBc IgG, and 36% of them had detectable HBV DNA in their sera. HBV DNA(+) patient had two times higher risk of having poor response to HCC intervention treatment more than patients with serum HBV DNA(−). Previous exposure to HBV had a strong association with HCC in CHC patients, and OBI is an independent risk factor for poor response to intervention treatment of HCC.