Prediction of hepatocellular carcinoma risk in chronic hepatitis B and C:review of findings in REVEAL-HBV/HCV study

Both hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of hepatocellular carcinoma (HCC) .An estimated 350 million people worldwide are living with chronic HBV infection, and 200 million with chronic HCV infection.Each year, an estimated 500 000 people die of HCC caused by chronic HBV infection, and another 200 000 HCC cases caused by chronic HCV infection.The most important predictors of HCC risk in persons who have chronic HBV infection are persistently elevated serum levels of HBV DNA and alanine aminotransferase (ALT) .Other HCC risk predictors for chronic hepatitis B patients include HBV genotype C infection, HBV basal core promoter A1762T/G1764A mutants, male sex, older age, family HCC history, habitual alcohol consumption, and co-infection with HCV or HIV.Based on the dataset of REVEAL-HBV study, easy-to-use nomograms using noninvasive clinical characteristics have been developed for accurate prediction of hepatocellular carcinoma risk in patients with chronic hepatitis B.The most important predictors of HCC risk in persons who have chronic HCV infection include elevated serum levels of HCV RNA and ALT, HCV genotype and older age.In the REVEAL-HCV study, participants with detectable HCV RNA level, elevated serum ALT levels and genotype 1 HCV infection had the highest risk of hepatocellular carcinoma showing a multivariate-adjusted hazard ratio (95 percent confidence interval) of 21.87 (5.09-93.95) , compared with those with undetectable HCV RNA level and low serum ALT levels as the referent group.These findings have strong implications for the management of chronic hepatitis C.