Elevated levels of hepatitis B DNA and hepatitis B surface antigen correlated significantly with an increased risk for liver cancer, according to recently published data.
“Increasing evidences have suggested that a lower HBsAg level is associated with better clinical outcomes, including a higher likelihood of HBsAg loss, lower risk of [hepatitis B e antigen-negative] hepatitis, cirrhosis and [hepatocellular carcinoma],” the researchers wrote. “Clinical therapy of [chronic HBV] to simultaneously lower serum levels of both HBV DNA and HBsAg may be suggested to lower the risk of liver cancer, especially for those high-risk persons.”
The researchers conducted a nested case-control study within two large population-based cohorts in Shanghai to prospectively assess the risk for liver cancer by combining quantitative HBsAg level and viral load.
The study comprised 211 patients with liver cancer and 221 controls who were seropositive for HBsAg and followed for cancer occurrence every 2 to 3 years from 2000 to 2011.
Compared with controls, patients with liver cancer had lower family income (P = .05) and education level (P < .01), less vegetable intake (318.2 vs. 361.2 g/day; P = 0.2), and were more likely to have a history of chronic liver disease (48.34% vs. 15.84%; P < .01), family history of liver cancer (15.17% vs. 6.33%; P < .01), and a positive HBeAg status (37.91% vs. 5.88%; P < .01).
In three adjusted models, risk for liver cancer correlated positively with increased levels of HBV DNA (all, P < .01) and HBsAg (P < .01 to P = .03) in dose-response manners.
Compared with patients with HBV DNA less than 2,000 IU/mL, liver cancer risk increased among those with HBV DNA between 2,000 IU/mL and 19,999 IU/mL (OR = 2.11; 95% CI, 0.99-4.5) and those with HBV DNA higher than 20,000 IU/mL (OR = 3.12; 95% CI, 2.19-4.44).
Similarly, compared with patients with HBsAg levels of 0.05 IU/mL to 99 IU/mL, liver cancer risk increased among those with HBsAg levels of 100 IU/mL to 999 IU/mL (OR = 1.82; 95% CI. 0.9-3.68) and those with HBsAg levels higher than 1,000 IU/mL (OR = 2.21; 95% CI, 1.1-4.43).
The researchers stratified HBsAg cut-off levels by HBV DNA for liver cancer risk. Among patients with HBV DNA less than 2,000 IU/mL, those with HBsAg levels of 100 IU/mL or higher (OR = 1.98; 95% CI, 0.96-4.11) and those with HBsAg levels of 1,000 IU/mL and higher (OR = 1.05; 95% CI, 0.42-2.59) both had an increased risk for liver cancer.
Additionally, among patients with HBV DNA higher than 2,000, liver cancer risk increased among those with HBsAg levels higher than 100 IU/mL (OR = 3.72; 95% CI, 1.17-11.82) compared with less than 100 IU/mL and among those with HBsAg levels higher than 1,000 IU/mL (OR = 2.6; 95% CI, 1.11-6.05) compared with those with less than 1,000 IU/mL.
“We observed a positive correlation between HBV DNA and HBsAg levels,” the researchers concluded. “Previous studies indicated that the correlation changed during the natural history of HBV infection, higher at HBeAg-positive phase, lower at HBeAg-negative phase and the lowly replicative phase, which was consistent with our findings.”
By Talitha Bennett