Incidence of hepatocellular carcinoma according to hepatitis B virus genotype in Alaska Native people

• Published in: Liver international 2016-10, Vol.36 (10), p.1507-1515
• Main Authors: Ching, Lance K., Gounder, Prabhu P., Bulkow, Lisa, Spradling, Philip R., Bruce, Michael G., Negus, Susan, Snowball, Mary, McMahon, Brian J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alaska Natives; Carcinoma, Hepatocellular - ethnology; epidemiology; Female; genomics; Genotype; Hepatitis B e Antigens - blood; Hepatitis B virus - genetics; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - ethnology; Humans; Incidence; liver cancer; Liver Neoplasms - ethnology; Logistic Models; Male; Middle Aged; Native American; Odds Ratio; Retrospective Studies; risk factors; United States - epidemiology
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13129

Background & Aims Most regions of the world have ≤3 co‐circulating hepatitis B virus (HBV) genotypes, which limits direct comparisons of hepatocellular carcinoma (HCC) risk among HBV‐infected persons by genotype. We evaluated HCC incidence by HBV genotype in a cohort of Alaska Native (AN) persons where five HBV genotypes (A, B, C, D, F) have been identified. Methods Our cohort comprised AN persons with chronic HBV infection identified during 1983–2012 who consented to participate in this study. Cohort persons were offered annual hepatitis B e antigen (HBeAg) testing and semi‐annual HCC screening. We developed a logistic regression model to compare HCC risk by genotype, adjusting for age, sex, region and HBeAg status. Results Among the 1235 consenting study participants, 711 (57.6%) were male, 510 (41.3%) were HBeAg positive at cohort entry and 43 (3.5%) developed HCC. The HBV genotype was known for 1142 (92.5%) persons (13.5% A, 3.9% B, 6.7% C, 56.9% D, 19.0% F). The HCC incidence/1000 person‐years of follow‐up for genotypes A, B, C, D and F was 1.3, 0, 5.5, 0.4 and 4.2 respectively. Compared with persons with HBV genotype B/D infection, the HCC risk was higher for persons with genotypes A [adjusted odds ratio (aOR): 3.9, 95% confidence interval (CI): 1.14–13.74], C (aOR: 16.3, 95% CI: 5.20–51.11) and F (aOR: 13.9, 95% CI: 5.30–36.69). Conclusion HBV genotype is independently associated with HCC risk. AN persons with genotypes A, C and F are at higher risk compared with genotypes B or D.