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E. Kaklamani, MD; D. Trichopoulos, MD; A. Tzonou, DMSc; X. Zavitsanos, MD; Y. Koumantaki, MD; A. Hatzakis, MD; C. C. Hsieh, DSc; S. Hatziyannis, MD

JAMA. 1991;265(15):1974-1976.

Abstract
Serum taken from patients in a case-control study in Athens, Greece, was used to examine the interactive roles of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the origin of hepatocellular carcinoma (HCC). An enzyme immunoassay for anti-HCV was used to test serum taken from 185 cases with HCC, 35 cases with metastatic liver cancer (MLC), and 432 hospital controls. Weakly positive anti-HCV results were more strongly related to MLC than to HCC, implying that these anti-HCV results are false positive. By contrast, strongly positive anti-HCV results were significantly related to HCC (relative risk [RR], 6.3), whereas no significant association was evident for MLC (RR, 0.6). The association of anti-HCV with HCC was substantially higher among subjects whose radioimmunoassay was positive for hepatitis B surface antigen (RR, 20.0) than among those whose radioimmunoassay was negative for this marker (RR, 4.8). These findings indicate that HCV infection has an interactive role in the origin of HCC.

(JAMA. 1991;265:1974-1976)

Author Affiliations
From the Department of Epidemiology, Harvard School of Public Health, Boston, Mass (Drs Trichopoulos and Hsieh); the Department of Hygiene and Epidemiology, University of Athens (Greece) Medical School (Drs Kaklamani, Tzonou, Zavitsanos, Koumantaki, and Hatzakis); and Academic Department of Medicine, Ippokrateion Hospital, Athens, Greece (Dr Hatziyannis).

Footnotes
Reprint requests to Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr Trichopoulos).

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