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Tedesco CC, Bonfiglio C, Notarnicola M, Rendina M, Castellaneta A, Di Leo A, Giannelli G, Fontana L. High Extra Virgin Olive Oil Consumption Is Linked to a Lower Prevalence of NAFLD with a Prominent Effect in Obese Subjects: Results from the MICOL Study. Nutrients 2023; 15:4673. [PMID: 37960329 PMCID: PMC10647576 DOI: 10.3390/nu15214673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Extra virgin olive oil (EVOO) has healthy benefits for noncommunicable diseases (NCDs). However, limited evidence is available about the effects of liver disease and non-alcoholic fatty liver disease (NAFLD). We evaluate whether dose-increased consumption of EVOO is associated with a lower prevalence of NAFLD and if these effects vary based on body weight. The study included 2436 subjects with a 33% NAFLD prevalence. Daily EVOO was categorized into tertiles: low (0-24 g/day), moderate (25-37 g/day), and high consumption (>37 g/day). Subjects were also classified by body mass index (BMI) as normo-weight (18.5-24.9), overweight (25-29.9), and obese (≥30). Logistic regression analysis was applied to calculate odds ratios (ORs) for NAFLD, considering a 20-gram increment in EVOO intake and accounting for EVOO categories combined with BMI classes. The ORs were 0.83 (0.74;0.93) C.I. p = 0.0018 for continuous EVOO, 0.89 (0.69;1.15) C.I. p = 0.37, and 0.73 (0.55;0.97) C.I. p = 0.03 for moderate and high consumption, respectively, when compared to low consumption. Overall, the percent relative risk reductions (RRR) for NAFLD from low to high EVOO consumption were 18% (16.4%;19.2%) C.I. and 26% (25%;27.4%) C.I. in overweight and obese subjects. High EVOO consumption is associated with a reduced risk of NAFLD. This effect is amplified in overweight subjects and even more in obese subjects.
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Affiliation(s)
- Calogero Claudio. Tedesco
- Data Science Unit, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy
| | - Caterina Bonfiglio
- Laboratory of Epidemiology and Statistics, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Maria Rendina
- Gastroenterology and Digestive Endoscopy, University Hospital, Policlinico of Bari, 70100 Bari, Italy;
| | - Antonino Castellaneta
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70100 Bari, Italy; (A.C.); (A.D.L.)
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70100 Bari, Italy; (A.C.); (A.D.L.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology, IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy;
| | - Luigi Fontana
- Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW 2006, Australia
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Bonfiglio C, Cuccaro F, Campanella A, Rosso N, Tatoli R, Giannelli G, Donghia R. Effect of Intake of Extra Virgin Olive Oil on Mortality in a South Italian Cohort with and without NAFLD. Nutrients 2023; 15:4593. [PMID: 37960246 PMCID: PMC10649270 DOI: 10.3390/nu15214593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Extra-virgin olive oil (EVOO) is the main source of seasoning fat in the Mediterranean diet and it is one of the components with known protective factors on chronic-degenerative disease. We aimed to evaluate the effect of a medium-high level of oil consumption on mortality in a cohort with good adherence to the Mediterranean diet. METHODS A total of 2754 subjects who had completed the food questionnaire in the Multicenter Italian study on Cholelithiasis (MICOL) cohort were included in the study. EVOO consumption was categorized in four levels (<20 g/die, 21-30 g/die, 31-40 g/die, >40 g/die). We performed a flexible parametric survival model to assess mortality by EVOO consumption level adjusted for some covariates. We also performed the analysis on subjects with and without non-alcoholic fatty liver disease (NAFLD) to evaluate the effects of oil in this more fragile sub-cohort. RESULTS We found a statistically significant negative effect on mortality for the whole sample when EVOO consumption was used, both as a continuous variable and when categorized. The protective effect was stronger in the sub-cohort with NAFLD, especially for the highest levels of EVOO consumption (HR = 0.58 with p < 0.05). CONCLUSIONS Our study has shown a protective effect of EVOO consumption towards all causes of mortality. Despite the higher caloric intake, the protective power is greater for a consumption >40 g/day in both the overall cohort and the sub-cohorts with and without NAFLD.
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Affiliation(s)
- Caterina Bonfiglio
- National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (A.C.); (R.T.); (G.G.)
| | | | - Angelo Campanella
- National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (A.C.); (R.T.); (G.G.)
| | - Natalia Rosso
- Fondazione Italiana Fegato, AREA Sciegce Park, Basovizza, 34149 Trieste, Italy;
| | - Rossella Tatoli
- National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (A.C.); (R.T.); (G.G.)
| | - Gianluigi Giannelli
- National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (A.C.); (R.T.); (G.G.)
| | - Rossella Donghia
- National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy; (A.C.); (R.T.); (G.G.)
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Effects of weight change on all causes, digestive system and other causes mortality in Southern Italy: a competing risk approach. Int J Obes (Lond) 2022; 46:113-120. [PMID: 34522001 DOI: 10.1038/s41366-021-00954-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
Weight change is associated with all causes of death, cardiovascular, and cancer mortality and a heterogeneous group of other causes of death. We aimed to estimate the effect of weight change on all causes and cause-specific mortality in a cohort with a high prevalence of deaths due to diseases of the digestive system.MethodsIn this prospective cohort study, 2230 subjects aged 30 to 50 years were examined. The study consisted of a 32-year longitudinal study period (January 1985 to December 2017) and mortality follow-up. Outcomes were mortality from all causes and deaths from gastrointestinal disease. Root Mean Squared Error (RMSE) was evaluated to capture individual residual variation in Body Mass Index (BMI) after adjustment for baseline BMI, and the relationship of residual variation with mortality was calculated as cumulative incidence function and cause-specific hazard (CSH) rate.ResultsIn total, 793 participants died during the follow-up, 96 of them due to Digestive system causes. Magnitude of residual variation weight in the last quintile was associated with all-cause mortality (relative risk, 2.00; 95% CI, 1.54-2.59) and Digestive system causes (relative risk, 3.82; 95% CI, 1.86-7.81).ConclusionThe findings suggest an association between weight change and gastrointestinal disease mortality. Epidemiological works studying the correlation between weight change and mortality should consider this aspect.
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Mirizzi A, Aballay LR, Misciagna G, Caruso MG, Bonfiglio C, Sorino P, Bianco A, Campanella A, Franco I, Curci R, Procino F, Cisternino AM, Notarnicola M, D’Aprile PF, Osella AR. Modified WCRF/AICR Score and All-Cause, Digestive System, Cardiovascular, Cancer and Other-Cause-Related Mortality: A Competing Risk Analysis of Two Cohort Studies Conducted in Southern Italy. Nutrients 2021; 13:nu13114002. [PMID: 34836259 PMCID: PMC8620807 DOI: 10.3390/nu13114002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background: In real life, nutrition goes beyond purely biological domains. Primary prevention is the most efficient approach for reducing the risk of mortality. We aimed to study the association of lifestyle, as measured by a modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) scoring system with all-cause, digestive system disease-related (DSD-related), cardiovascular disease-related (CVD-related), cancer–related and other cause-related mortality using data from two population-based cohort studies conducted in Southern Italy. Methods: A random sample of 5271 subjects aged 18 years or older was enrolled in 2005–2006 and followed up until 2020. Usual food intakes were estimated using a validated dietary questionnaire. Competing risks survival models were applied. Results: High adherence to the mWCRF/AICR score was found to be statistically significant and negatively associated with all-cause mortality (HR 0.56, 95%CI 0.39; 0.82), DSD-related mortality (SHR 0.38, 95%CI 0.15; 0.97) and cancer-related mortality (SHR 0.43, 95%CI 0.19; 0.97) in the male sub-cohort and other-cause mortality (SHR 0.43, 95%CI 0.21; 0.88) only in the female group. Conclusions: This mWCRF/AICR score can be seen as a simple, easy tool for use in clinical practice to evaluate both qualitative and quantitative aspects of the diet.
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Affiliation(s)
- Antonella Mirizzi
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Laura R. Aballay
- Human Nutrition Research Center (CenINH), School of Nutrition, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Córdoba X5000, Argentina;
| | - Giovanni Misciagna
- Scientific and Ethical Committee Polyclinic Hospital, University of Bari, 70124 Bari, Puglia, Italy; (G.M.); (M.G.C.)
| | - Maria G. Caruso
- Scientific and Ethical Committee Polyclinic Hospital, University of Bari, 70124 Bari, Puglia, Italy; (G.M.); (M.G.C.)
- Clinical Nutrition Outpatients Clinic, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy;
| | - Caterina Bonfiglio
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Paolo Sorino
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Antonella Bianco
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Angelo Campanella
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Isabella Franco
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Ritanna Curci
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Filippo Procino
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Anna M. Cisternino
- Clinical Nutrition Outpatients Clinic, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy;
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry (MN), National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy;
| | - Pierina F. D’Aprile
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
| | - Alberto R. Osella
- Laboratory of Epidemiology and Biostatistics, National Gastroenterology Institute, “S. de Bellis” Research Hospital, Via Turi 27, 70013 Castellana Grotte, Bari, Italy; (A.M.); (C.B.); (P.S.); (A.B.); (A.C.); (I.F.); (R.C.); (F.P.); (P.F.D.)
- Correspondence: ; Tel.: +39-0804994655; Fax: +39-0804994650
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Piselli P, Serraino D, Fusco M, Girardi E, Pirozzi A, Toffolutti F, Cimaglia C, Taborelli M. Hepatitis C virus infection and risk of liver-related and non-liver-related deaths: a population-based cohort study in Naples, southern Italy. BMC Infect Dis 2021; 21:667. [PMID: 34238231 PMCID: PMC8268172 DOI: 10.1186/s12879-021-06336-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Background Hepatitis C virus (HCV) infection represents a global health issue with severe implications on morbidity and mortality. This study aimed to evaluate the impact of HCV infection on all-cause, liver-related, and non-liver-related mortality in a population living in an area with a high prevalence of HCV infection before the advent of Direct-Acting Antiviral (DAA) therapies, and to identify factors associated with cause-specific mortality among HCV-infected individuals. Methods We conducted a cohort study on 4492 individuals enrolled between 2003 and 2006 in a population-based seroprevalence survey on viral hepatitis infections in the province of Naples, southern Italy. Study participants provided serum for antibodies to HCV (anti-HCV) and HCV RNA testing. Information on vital status to December 2017 and cause of death were retrieved through record-linkage with the mortality database. Hazard ratios (HRs) for cause-specific mortality and 95% confidence intervals (CIs) were estimated using Fine-Grey regression models. Results Out of 626 deceased people, 20 (3.2%) died from non-natural causes, 56 (8.9%) from liver-related conditions, 550 (87.9%) from non-liver-related causes. Anti-HCV positive people were at higher risk of death from all causes (HR = 1.38, 95% CI: 1.12–1.70) and liver-related causes (HR = 5.90, 95% CI: 3.00–11.59) than anti-HCV negative ones. Individuals with chronic HCV infection reported an elevated risk of death due to liver-related conditions (HR = 6.61, 95% CI: 3.29–13.27) and to any cause (HR = 1.51, 95% CI: 1.18–1.94). The death risk of anti-HCV seropositive people with negative HCV RNA was similar to that of anti-HCV seronegative ones. Among anti-HCV positive people, liver-related mortality was associated with a high FIB-4 index score (HR = 39.96, 95% CI: 4.73–337.54). Conclusions These findings show the detrimental impact of HCV infection on all-cause mortality and, particularly, liver-related mortality. This effect emerged among individuals with chronic infection while those with cleared infection had the same risk of uninfected ones. These results underline the need to identify through screening all people with chronic HCV infection notably in areas with a high prevalence of HCV infection, and promptly provide them with DAAs treatment to achieve progressive HCV elimination and reduce HCV-related mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06336-9.
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Affiliation(s)
- Pierluca Piselli
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - Mario Fusco
- Registro Tumori, ASL Napoli-3 Sud, Brusciano, Naples, Italy
| | - Enrico Girardi
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Angelo Pirozzi
- Registro Tumori, ASL Napoli-3 Sud, Brusciano, Naples, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, PN, Italy
| | - Claudia Cimaglia
- Department of Epidemiology and Pre-Clinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, via Franco Gallini 2, 33081, Aviano, PN, Italy.
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Campanella A, Misciagna G, Mirizzi A, Caruso MG, Bonfiglio C, Aballay LR, Vas de Arruda Silveira L, Bianco A, Franco I, Sorino P, Buongiorno C, Cisternino AM, Notarnicola M, Guerra VMB, Osella AR. The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy. Int J Epidemiol 2021; 50:245-255. [PMID: 33156916 DOI: 10.1093/ije/dyaa222] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Mediterranean diet (MedDiet) is associated with good health. We aimed to estimate the effect of levels of adherence to the MedDiet on lifespan by performing treatment effects survival analysis. METHODS A sample of 5250 subjects aged ≥18 years were randomly selected from the electoral list of Castellana Grotte and Putignano (Apulian Region, Italy). Cohorts were enrolled in 2005-06 and followed-up until December 2018. The adherence to the MedDiet was measured by the relative Mediterranean score (rMED) and categorized as high, medium and low. Time-to-death (all-causes) as estimated by average treatment effect on the treated (ATET), potential outcome mean (POM) and relative efficiency of exposure were the outcomes. RESULTS A total of 4896 subjects were included. The median follow-up time was 12.82 (inter quartile range (IQR) 12.22-13.05), 12.91 (IQR 12.21-13.27) and 12.84 (IQR 12.19-13.03) years for high, medium and low rMED subjects respectively. By December 2018, 453 (9.25%) had died. There was a strong effect of medium and low rMED {ATET, -5.10 [95% confidence interval (CI) -9.39, -0.80] and -8.91 (95%CI -13.37, -4.45), respectively}. High rMED has an important effect on mean age at death [POM 90.16 (95% CI 86.06, 94.25)]. The relative effect size for medium and low rMED subjects was a lower lifespan of 5.62% (95% CI 1.01, 10.3) and 9.90% (95% CI 5.30, 5.30), respectively. CONCLUSIONS We observed an important benefit in additional years of survival from adherence to MedDiet in this southern Italian cohort. Further investigation corroborating our findings in other population groups in other geographic regions will be an important contribution to promoting health and longevity.
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Affiliation(s)
- Angelo Campanella
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Clinical Nutrition Outpatients Clinic, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Giovanni Misciagna
- Scientific and Ethical Committee Polyclinic Hospital, University of Bari, Italy
| | - Antonella Mirizzi
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Maria Gabriella Caruso
- Clinical Nutrition Outpatients Clinic, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana Grotte, (BA), Italy
| | - Caterina Bonfiglio
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Laura R Aballay
- Human Nutrition Research Center (CenINH), School of Nutrition, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Antonella Bianco
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Isabella Franco
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Paolo Sorino
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Claudia Buongiorno
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Anna Maria Cisternino
- Clinical Nutrition Outpatients Clinic, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy
| | - Maria Notarnicola
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy
| | - Vito M B Guerra
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
| | - Alberto R Osella
- Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana, Grotte, (BA), Italy.,Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology 'S de Bellis' Research Hospital, Castellana , Grotte, (BA), Italy
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7
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Pozzato G, Mazzaro C, Gattei V. Hepatitis C virus-associated non-Hodgkin lymphomas: the endless history. Minerva Med 2020; 112:215-227. [PMID: 33263375 DOI: 10.23736/s0026-4806.20.07184-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hepatitis C virus (HCV) is a global population problem due to its high prevalence worldwide. In the prognosis of patients with HCV not only hepatic but increasingly frequent of extrahepatic HCV manifestations, such as mixed cryoglobulinemia (MC) and non-Hodgkin's lymphoma (NHL), are important. The role of the HCV virus in the pathogenesis of lymphoproliferative diseases is confirmed by a large number of epidemiological studies, as well as by the effectiveness of antiviral therapy in patients with non-Hodgkin's lymphoma (NHL). The purpose of the review was to provide an overview of epidemiological and biological data explaining the role of HCV in the development of NHL. The review also discusses HCV-associated NHL treatment by the traditional antiviral therapy (interferon and ribavirin) and by the new direct antiviral agents.
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Affiliation(s)
- Gabriele Pozzato
- Department of Clinical and Surgical Sciences, Maggiore Hospital, University of Trieste, Trieste, Italy -
| | - Cesare Mazzaro
- Unit of Clinical and Experimental Onco-Hematology, CRO Aviano National Cancer Institute IRCCS, Aviano, Pordenone, Italy
| | - Valter Gattei
- Unit of Clinical and Experimental Onco-Hematology, CRO Aviano National Cancer Institute IRCCS, Aviano, Pordenone, Italy
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Bonfiglio C, Leone CM, Silveira LVA, Guerra R, Misciagna G, Caruso MG, Bruno I, Buongiorno C, Campanella A, Guerra VMB, Notarnicola M, Deflorio V, Franco I, Bianco A, Mirizzi A, Aballay LR, Cisternino AM, Sorino P, Pesole PL, Osella AR. Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis. Nutr Metab Cardiovasc Dis 2020; 30:2093-2102. [PMID: 32819783 DOI: 10.1016/j.numecd.2020.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/08/2020] [Accepted: 07/01/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs). METHODS AND RESULTS Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L). CONCLUSIONS RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.
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Affiliation(s)
- Caterina Bonfiglio
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Carla M Leone
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Liciana V A Silveira
- Department of Biostatistics, Biosciences Institute, São Paulo State University, Av Rubião Jr.-Centro, Botucatu-SP, 18618-970 Botucatu, São Paulo, Brazil (Liciana V.A. Silveira)
| | - Rocco Guerra
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Giovanni Misciagna
- Scientific and Ethical Committee, Policlinic Hospital, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, BA, Italy (Giovanni Misciagna)
| | - Maria G Caruso
- Laboratory of Nutritional Biochemistry National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Maria Gabriella Caruso, Maria Notarnicola); Clinical Nutrition Outpatient Clinic National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Anna Maria Cisternino)
| | - Irene Bruno
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Claudia Buongiorno
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Angelo Campanella
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Vito M B Guerra
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Maria Gabriella Caruso, Maria Notarnicola)
| | - Valentina Deflorio
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Isabella Franco
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Antonella Bianco
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Antonella Mirizzi
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Laura R Aballay
- Human Nutrition Research Center (CenINH), School of Nutrition, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Córdoba, Argentina; Enrique Barros Pabellón Biología Celular, Ciudad Universitaria, X5000 Córdoba, Argentina
| | - Anna M Cisternino
- Clinical Nutrition Outpatient Clinic National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Anna Maria Cisternino)
| | - Paolo Sorino
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino)
| | - Pasqua L Pesole
- Laboratory of Clinical Pathology, National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Pasqua Letizia Pesole)
| | - Alberto R Osella
- Laboratory of Epidemiology and Biostatistics National Institute of Gastroenterology, "S de Bellis" Research Hospital, Via Turi 27, 70013 Castellana Grotte, BA, Italy (Alberto Ruben Osella, Caterina Bonfiglio, Carla Maria Leone, Rocco Guerra, Irene Bruno Claudia Buongiorno, Angelo Campanella, Vito Maria Bernardo Guerra, Valentina Deflorio, Isabella Franco, Antonella Bianco, Antonella Mirizzi, Paolo Sorino).
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9
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Pozzato G, Mazzaro C, Gattei V. Hepatitis C Virus-Associated Non-Hodgkin Lymphomas: Biology, Epidemiology, and Treatment. Clin Liver Dis 2017; 21:499-515. [PMID: 28689589 DOI: 10.1016/j.cld.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Eradication of hepatitis C virus (HCV) in indolent non-Hodgkin lymphomas (NHLs), especially in marginal zone lymphomas, determines the regression of the hematologic disorder in a significant fraction of cases. Because direct antiviral agents show an excellent profile in terms of efficacy, safety, and rapid onset of action, these drugs can be used in any clinical situation and in the presence of any comorbidities. To avoid the progression of the NHL, despite HCV eradication, antiviral therapy should be provided as soon as the viral infection is discovered; before that, the chronic antigenic stimulation determines the irreversible proliferation of neoplastic B cells.
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Affiliation(s)
- Gabriele Pozzato
- Department of Clinical and Surgical Sciences, University of Trieste, Ematologia Clinica, Ospedale Maggiore, Piazza Ospedale 1, Trieste 34121, Italy.
| | - Cesare Mazzaro
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano 33081, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico, I.R.C.C.S., Aviano 33081, Italy
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10
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Temporal dynamics of hepatitis C genotypes in a five-year hospital-based surveillance in Northern Italy. Arch Virol 2016; 161:2727-37. [DOI: 10.1007/s00705-016-2975-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 07/06/2016] [Indexed: 02/06/2023]
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11
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Mostafa A, Shimakawa Y, Medhat A, Mikhail NN, Chesnais CB, Arafa N, Bakr I, El Hoseiny M, El-Daly M, Esmat G, Abdel-Hamid M, Mohamed MK, Fontanet A. Excess mortality rate associated with hepatitis C virus infection: A community-based cohort study in rural Egypt. J Hepatol 2016; 64:1240-6. [PMID: 26921686 DOI: 10.1016/j.jhep.2016.02.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS >80% of people chronically infected with hepatitis C virus (HCV) live in resource-limited countries, yet the excess mortality associated with HCV infection in these settings is poorly documented. METHODS Individuals were recruited from three villages in rural Egypt in 1997-2003 and their vital status was determined in 2008-2009. Mortality rates across the cohorts were compared according to HCV status: chronic HCV infection (anti-HCV antibody positive and HCV RNA positive), cleared HCV infection (anti-HCV antibody positive and HCV RNA negative) and never infected (anti-HCV antibody negative). Data related to cause of death was collected from a death registry in one village. RESULTS Among 18,111 survey participants enrolled in 1997-2003, 9.1% had chronic HCV infection, 5.5% had cleared HCV infection, and 85.4% had never been infected. After a mean time to follow-up of 8.6years, vital status was obtained for 16,282 (89.9%) participants. When compared to those who had never been infected with HCV in the same age groups, mortality rate ratios (MRR) of males with chronic HCV infection aged <35, 35-44, and 45-54years were 2.35 (95% CI 1.00-5.49), 2.87 (1.46-5.63), and 2.22 (1.29-3.81), respectively. No difference in mortality rate was seen in older males or in females. The all-cause mortality rate attributable to chronic HCV infection was 5.7% (95% CI: 1.0-10.1%), while liver-related mortality was 45.5% (11.3-66.4%). CONCLUSIONS Use of a highly potent new antiviral agent to treat all villagers with positive HCV RNA may reduce all-cause mortality rate by up to 5% and hepatic mortality by up to 40% in rural Egypt.
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Affiliation(s)
- Aya Mostafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Ahmed Medhat
- Department of Gastroenterology & Tropical Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nabiel N Mikhail
- Department of Biostatistics and Cancer Epidemiology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Cédric B Chesnais
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; UMI 233, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Naglaa Arafa
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Iman Bakr
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mostafa El Hoseiny
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mai El-Daly
- Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Gamal Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Abdel-Hamid
- Viral Hepatitis Research Laboratory, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt; Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Mostafa K Mohamed
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Arnaud Fontanet
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; Département d'Infection et Épidémiologie, Conservatoire National des Arts et Métiers, Paris, France.
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12
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Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014; 12:1500-24. [PMID: 25046751 DOI: 10.1016/j.ijsu.2014.07.014] [Citation(s) in RCA: 1578] [Impact Index Per Article: 157.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research.
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13
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Hepatitis C virus and non-Hodgkin’s lymphoma: biology, epidemiology and therapy. Oncol Rev 2011. [DOI: 10.1007/s12156-011-0087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Tan YW. Antiviral treatment of hepatitis B virus and hepatitis C virus co-infection. Shijie Huaren Xiaohua Zazhi 2011; 19:1614-1619. [DOI: 10.11569/wcjd.v19.i15.1614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are among the most common causes of advanced chronic liver disease worldwide. HBV/HCV co-infection is not uncommon with an estimated 7-20 million individuals affected worldwide. Patients with HBV/HCV co-infection have an increased risk of cirrhosis, hepatocellular carcinoma (HCC), and even death. The pathophysiology of HBV/HCV co-infection is complex, as different patterns of virological dominance may occur, which can even fluctuate over time. Recently, combination of pegylated interferon (PEG-IFN) plus ribavirin has been explored in HBV/HCV-coinfected patients who are positive for HCV-RNA. In this paper, we summarize the epidemiology, viral interaction and clinical features of HBV/HCV co-infection and the available treatment options. Detailed serological and virological evaluations are required for HBV/HCV-co-infected patients before initiation of antiviral therapy. At present, PEG-IFN-a plus ribavirin should be the treatment of choice in patients with dominant HCV replication. However, HBV rebound may occur after elimination of HCV, and thus close monitoring for both viruses is recommended even for patients with initially suppressed HBV DNA.
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Grebely J, Raffa JD, Lai C, Kerr T, Fischer B, Krajden M, Dore GJ, Tyndall MW. Impact of hepatitis C virus infection on all-cause and liver-related mortality in a large community-based cohort of inner city residents. J Viral Hepat 2011; 18:32-41. [PMID: 20196806 DOI: 10.1111/j.1365-2893.2010.01279.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to measure the impact of hepatitis C virus (HCV) infection on mortality in a cohort of inner city residents. The Community Health and Safety Evaluation is a community-based study of inner city residents followed retrospectively and prospectively through linkages with provincial virology and mortality databases. We identified participants having received HCV antibody testing, evaluated cause-specific mortality rates and factors associated with all-cause and liver-related mortality using Cox Proportional Hazards models. Overall, 2332 participants received HCV antibody testing (recent non-injection drug use - 81%). The prevalence of HCV and HIV was 64% (1495 of 2332) and 21% (485 of 2332), respectively. Between January 2003 and December 2007, there were 180 deaths (192 per 10.000 person-years; 95% CI: 165, 222), with 21% HIV-related, 20% drug-related and 7% liver-related. Mortality was associated with age >50 [adjusted hazard ratio (AHR) 2.80 vs < 40 years (referent group); 95% CI 1.93, 4.07, P < 0.001] and HIV infection (AHR 3.81; 95% CI 2.72, 5.34, P < 0.001), but not positive HCV antibody status (AHR 1.19; 95% CI 0.83, 1.72, P = 0.35). Liver-related mortality was associated with age >50 [AHR 18.49 vs < 40 years (referent group); 95% CI 2.27, 150.41, P < 0.001] and positive HCV antibody status (AHR 7.69; 95% CI 0.99, 59.98, P = 0.052). This study demonstrates a high rate of mortality in this population, particularly those with HIV. HCV-infected inner city residents >50 years of age were at significant risk of liver-related mortality. Continued surveillance of this population infected with HCV in the 1970s and 1980s is important.
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Affiliation(s)
- J Grebely
- National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Sydney, NSW, Australia.
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Abstract
IMPORTANCE OF THE FIELD Hepatitis B (HBV) and hepatitis C (HCV) virus infections are among the most common causes of advanced chronic liver disease worldwide. HBV/HCV coinfection is not uncommon with an estimated 7 - 20 million individuals affected worldwide. Patients with HBV/HCV coinfection have an increased risk for cirrhosis, hepatocellular carcinoma (HCC) and even death. AREAS COVERED IN THIS REVIEW The pathophysiology of HBV/HCV coinfection is complex, as different patterns of virological dominance may occur, which can even fluctuate over time. Recently, combination of pegylated interferon (PEG-IFN) plus ribavirin has been explored in HBV/HCV coinfected patients who are positive for HCV-RNA. HBV polymerase inhibitors may be indicated if HBV-DNA concentrations are above 2000 IU/ml. In this review, we summarize the epidemiology, viral interaction, its clinical features and the available treatment options. WHAT THE READER WILL GAIN Insights into viral interaction of HBV/HCV coinfection and treatment individualization strategies are provided in the review. TAKE HOME MESSAGE Detailed serological and virological evaluations are required for HBV/HCV coinfected patients before initiation of antiviral therapy. At present, PEG-IFN-alpha plus ribavirin should be the treatment of choice in patients with dominant HCV replication. However, HBV rebound may occur after elimination of HCV, and thus close monitoring for both viruses is recommended even for patients with initially suppressed HBV-DNA.
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Affiliation(s)
- Andrej Potthoff
- Hannover Medical School, Medizinische Hochschule Hannover, Department of Gastroenterology, Hepatology and Endocrinology, Carl Neuberg Str. 1, D-30625 Hannover, Germany
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Chang KC, Tsai PS, Hsu MC, Hung SF, Tsai CC, Lu SN. Chronic hepatitis C increased the mortality rates of patients with hepatocellular carcinoma and diabetes mellitus in a triple hepatitis virus endemic community. J Gastroenterol 2010; 45:636-45. [PMID: 20054698 DOI: 10.1007/s00535-009-0189-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Accepted: 12/08/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND To elucidate the factors associated with mortality rates among older subjects with hepatocellular carcinoma (HCC) and diabetes mellitus (DM) in a triple hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis delta virus (HDV) endemic community. METHODS A total of 2,909 residents aged>or=45 years were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV) and alanine aminotransaminase (ALT) in 1997. Anti-HDV was detected in HBsAg-positive subjects. Those who expired from HCC and DM were identified from official mortality data sets (1997-2003). Survival was analyzed using the Kaplan-Meier survival curve with log-rank test and the Cox proportional hazard model. RESULTS Forty-one patients died of HCC and 25 of DM during the study period. Multivariate analysis indicated that age>or=65 years (hazard ratio 3.4; 95% confidence interval 1.8-6.4), HBsAg (3.3; 1.7-6.7), anti-HCV (3.8; 1.7-8.5) and ALT>or=40 IU/L (3.7; 1.9-7.0) were independent predictors of HCC mortality, while age>or=65 years (4.8; 2.1-11.0) and anti-HCV (4.2; 1.7-10.6) were two independent predictors of DM mortality. There were synergistic effects of dual viral infections for HCC, but not for DM mortality. CONCLUSIONS Old age and chronic HCV infection increase the risk of HCC and DM mortality. HBsAg and ALT levels are also risk factors for HCC mortality, but not DM. The synergistic effects of dual hepatitis viral infections are demonstrable and warrant further investigation.
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Affiliation(s)
- Kuo-Chin Chang
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, #123, Ta Pei Road, Niao Sung 833, Kaohsiung, Taiwan
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Prasad L, Spicher VM, Negro F, Rickenbach M, Zwahlen M. Little evidence that hepatitis C virus leads to a higher risk of mortality in the absence of cirrhosis and excess alcohol intake: the Swiss Hepatitis C Cohort Study. J Viral Hepat 2009; 16:644-9. [PMID: 19243494 DOI: 10.1111/j.1365-2893.2009.01113.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study was to describe the all-cause mortality of participants in the Swiss Hepatitis C Cohort compared to the Swiss general population. Patients with hepatitis C virus (HCV) infection attending secondary and tertiary care centres in Switzerland. One thousand six hundred and forty-five patients with HCV infection were followed up for a mean of over 2 years. We calculated all-cause standardized mortality ratios (SMR) and 95% confidence intervals (CI) using age, sex and calendar year-specific Swiss all-cause mortality rates. Multivariable Poisson regression was used to model the variability of SMR by cirrhotic status, HCV genotype, infection with hepatitis B virus or HIV, injection drug use and alcohol intake. Sixty-one deaths were recorded out of 1645 participants. The crude all-cause SMR was 4.5 (95% CI: 3.5-5.8). Patients co-infected with HIV had a crude SMR of 20 (95% CI: 11.1-36.1). The SMR of 1.1 (95% CI: 0.63-2.03) for patients who were not cirrhotic, not infected with HBV or HIV, did not inject drugs, were not heavy alcohol consumers (<or=40 g/day) and were not genotype 3, indicated no strong evidence of excess mortality. We found little evidence of excess mortality in hepatitis C infected patients who were not cirrhotic, in the absence of selected risk factors. Our findings emphasize the importance of providing appropriate preventive advice, such as counselling to avoid alcohol intake, in those infected with HCV.
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Affiliation(s)
- L Prasad
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Vandenbroucke JP, Von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. [Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration]. GACETA SANITARIA 2009; 23:158. [PMID: 19249134 DOI: 10.1016/j.gaceta.2008.12.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research.
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Affiliation(s)
- Jan P Vandenbroucke
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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McDonald SA, Hutchinson SJ, Bird SM, Mills PR, Dillon J, Bloor M, Robertson C, Donaghy M, Hayes P, Graham L. A population-based record linkage study of mortality in hepatitis C-diagnosed persons with or without HIV coinfection in Scotland. Stat Methods Med Res 2008; 18:271-83. [DOI: 10.1177/0962280208094690] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Infection with the hepatitis C virus (HCV) is known to increase the risk of death from severe liver disease and, because HCV status is strongly associated with a history of injecting drug use, the effect of a key disease progression cofactor, infection with human immunodeficiency virus (HIV), is of interest . We examined all-cause, liver-related and drug-related mortality and excess risk of death from these causes in a large cohort of HCV-monoinfected and HIV-coinfected persons in Scotland. The study population consisted of 20,163 persons confirmed to be infected with hepatitis C through laboratory testing in Scotland between 1991 and 2005. Records with sufficient identifiers were linked to the General Register Office for Scotland death register to retrieve associated mortality data, and were further linked to a national database of HIV-positive individuals to determine coinfection status. A total of 1715 HCV monoinfected and 305 HIV coinfected persons died of any cause during the follow-up period (mean of 5.4 and 6.4 years, respectively). Significant excess mortality was observed in both HCV monoinfected and HIV coinfected populations from liver-related underlying causes (standardised mortality ratios of 25, 95% CI = 23—27; and 37, 95% CI = 26—52 for the two groups, respectively) and drug-related causes (25, 95% CI = 23—27; 39, 95% CI = 28—53. The risk of death from hepatocellular carcinoma, alcoholic or non-alcoholic liver disease, or from a drug-related cause, was greatly increased compared with the general Scottish population, with the highest standardised mortality ratio observed for hepatocellular carcinoma in the monoinfected group (70, 95% CI = 57—85). This study has revealed considerable excess mortality from liver- and drug-related causes in the Scottish HCV-diagnosed population; these data are crucial to inform on the clinical management, and projected future public health burden, of HCV infection.
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Affiliation(s)
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, United Kingdom, and Department of Statistics and Modelling Science, University of Strathclyde, Glasgow, United Kingdom
| | - Sheila M Bird
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, United Kingdom
| | | | - John Dillon
- Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Mick Bloor
- Centre for Drugs Misuse Research, University of Glasgow, Glasgow, United Kingdom
| | - Chris Robertson
- Health Protection Scotland, Glasgow, United Kingdom, Department of Statistics and Modelling Science, University of Strathclyde, Glasgow, United Kingdom
| | | | - Peter Hayes
- Edinburgh Royal Infirmary, Edinburgh, United Kingdom
| | - Lesley Graham
- Information Services Division, National Services Scotland, Edinburgh, United Kingdom
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Bedogni G, Miglioli L, Masutti F, Ferri S, Castiglione A, Lenzi M, Crocè LS, Granito A, Tiribelli C, Bellentani S. Natural course of chronic HCV and HBV infection and role of alcohol in the general population: the Dionysos Study. Am J Gastroenterol 2008; 103:2248-53. [PMID: 18637095 DOI: 10.1111/j.1572-0241.2008.01948.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Population-based studies of the natural course of chronic viral liver disease that consider comorbidity factors are lacking. Using data from the Dionysos Study, we quantified the burden of chronic viral liver disease and the role of alcohol intake to morbidity and mortality in a representative sample of subjects from the general population of two communities of Northern Italy. METHODS AND FINDINGS We followed up 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infection for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) yr, respectively. Ethanol intake was evaluated using a food-frequency questionnaire, fatty liver (FL) was diagnosed by ultrasonography, and liver cirrhosis (LC) and hepatocarcinoma (HCC) were diagnosed by liver biopsy. Exact multivariable Poisson regression was performed to identify predictors of death. The incidence and remission rates of FL were 9.0 and 29.7 in the HCV cohort and 4.0 and 30.4 per 1,000 person-years (PY) in the HBV cohort. Progression to LC and HCC was more common in the HCV than in the HBV cohort (4.5 vs 2.0 and 2.7 vs 2.0 per 1,000 PY, respectively). Ethanol intake was an independent predictor of LC in the HCV cohort [rate ratio (RR) = 4.15 (95% CI 1.02-41.2) for every increase of 30 g/day of ethanol intake at baseline] and of death rate in both cohorts [RR = 8.53 (95% CI 1.40-24.61) and 3.56 (1.34 to 26.50) for every increase of 30 g/day of ethanol intake at baseline]. CONCLUSIONS The morbidity and mortality rate of HBV and HCV infection in the general population is lower than that reported in secondary-care populations, blood donors, or clinical series. Ethanol intake is an independent predictor of LC in subjects with chronic HCV infection and an independent predictor of death in subjects with either HCV or HBV infection.
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Affiliation(s)
- Giorgio Bedogni
- Liver Research Center, AREA Science Park, Basovizza, Trieste, Italy
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Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4:e297. [PMID: 17941715 PMCID: PMC2020496 DOI: 10.1371/journal.pmed.0040297] [Citation(s) in RCA: 2963] [Impact Index Per Article: 174.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 08/30/2007] [Indexed: 02/06/2023] Open
Abstract
Much medical research is observational. The reporting of observational studies is often of insufficient quality. Poor reporting hampers the assessment of the strengths and weaknesses of a study and the generalisability of its results. Taking into account empirical evidence and theoretical considerations, a group of methodologists, researchers, and editors developed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations to improve the quality of reporting of observational studies. The STROBE Statement consists of a checklist of 22 items, which relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to cohort studies, case-control studies and cross-sectional studies and four are specific to each of the three study designs. The STROBE Statement provides guidance to authors about how to improve the reporting of observational studies and facilitates critical appraisal and interpretation of studies by reviewers, journal editors and readers. This explanatory and elaboration document is intended to enhance the use, understanding, and dissemination of the STROBE Statement. The meaning and rationale for each checklist item are presented. For each item, one or several published examples and, where possible, references to relevant empirical studies and methodological literature are provided. Examples of useful flow diagrams are also included. The STROBE Statement, this document, and the associated Web site (http://www.strobe-statement.org/) should be helpful resources to improve reporting of observational research.
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Affiliation(s)
- Jan P Vandenbroucke
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik von Elm
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Medical Biometry and Medical Informatics, University Medical Centre, Freiburg, Germany
| | - Douglas G Altman
- Cancer Research UK/NHS Centre for Statistics in Medicine, Oxford, United Kingdom
| | | | - Cynthia D Mulrow
- University of Texas Health Science Center, San Antonio, United States of America
| | - Stuart J Pocock
- Medical Statistics Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Poole
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, United States of America
| | - James J Schlesselman
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, and University of Pittsburgh Cancer Institute, Pittsburgh, United States of America
| | - Matthias Egger
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Social Medicine, University of Bristol, Bristol, United Kingdom
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Tacke F, Trautwein C. Causes of death in hepatitis B and/or C virus infected-people - lessons for clinical practice. Hepatology 2007; 45:1076-7. [PMID: 17393502 DOI: 10.1002/hep.21621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
- Frank Tacke
- Department of Medicine III, RWTH-University Hospital Aachen, Aachen, Germany
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Amin J, Law MG, Bartlett M, Kaldor JM, Dore GJ. Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study. Lancet 2006; 368:938-45. [PMID: 16962883 DOI: 10.1016/s0140-6736(06)69374-4] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Hepatitis B and hepatitis C virus infections are common causes of death related to liver disease. In this large study, we aimed to investigate all cause mortality of the viruses in a community-based setting. METHODS In the study population, 39,109 people had hepatitis B, 75,834 had hepatitis C, and 2604 had hepatitis B and hepatitis C co-infection, notified to the New South Wales state health department, Australia, between 1990 and 2002. Their data were probabilistically linked to the National Death Index. Standardised mortality ratios for all causes of death were calculated and adjusted for age, sex, and calendar year. RESULTS The number of deaths identified by the linkage were 1233 (3.2%) for hepatitis B, 4008 (5.3)% for hepatitis C, and 186 (7.1)% for hepatitis B and C co-infection. Raised risk of liver-related death (standardised mortality ratios 12.2, 95% CI 10.7-13.9; 16.8, 15.4-18.3, and 32.9, 23.1-46.7, for hepatitis B, hepatitis C, and hepatitis B and C co-infected patients, respectively) and drug-induced death (1.4, 1.0-2.0; 19.3, 18.1-20.5; and 24.7, 18.2-33.5, respectively) were detected. In people with hepatitis C, raised risk of dying from drug-related causes was significantly greater than from liver-related causes (p=0.012), with the greatest excess risk in women aged 15-24 years (56.9, 39.2-79.9). INTERPRETATION All groups had increased risk of liver-related death compared with the standard population, with the greatest excess in people diagnosed with hepatitis B and hepatitis C co-infection. Our data highlight that young people with hepatitis C and with co-infection face a higher mortality risk from continued drug use than from their infection, whereas the main cause of hepatitis B death was liver related.
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Affiliation(s)
- Janaki Amin
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, NSW 2010, Australia.
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Tanaka H, Tsukuma H, Yamano H, Oshima A, Shibata H. Prospective study on the risk of hepatocellular carcinoma among hepatitis C virus-positive blood donors focusing on demographic factors, alanine aminotransferase level at donation and interaction with hepatitis B virus. Int J Cancer 2004; 112:1075-80. [PMID: 15386355 DOI: 10.1002/ijc.20507] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The risk for hepatocellular carcinoma (HCC) among asymptomatic hepatitis C virus (HCV) carriers is not well understood. A community-based prospective study was conducted for over 8 years by record linkage to the Osaka Cancer Registry. The subjects were 1,927 individuals who were positive for anti-HCV through screening for second-generation HCV antibody (passive hemagglutination assay: >or= 2(12)) in voluntary blood donation. The risk factors for HCC and interaction between HCV and hepatitis B virus (HBV) infection were evaluated by including additional blood donors: 2,519 individuals positive for hepatitis B virus surface antigen (HBsAg) alone, 25 positive for both anti-HCV and HBsAg, 150,379 negative for both anti-HCV and HBsAg. The incidence of HCC (/10(5) person-years) among the HCV-positive individuals increased with age in both genders, ranging from 68 to 1,306 among those aged 45-74 years. In the HCV-positive individuals, the cumulative risk of developing HCC between the ages of 40 and 74 year was 21.6% among males and 8.7% among females. A stepwise increase in risk was noted as the serum alanine aminotransferase level increased or serum cholesterol level at baseline decreased in multivariate Cox proportional hazard analysis. The 9-year cumulative incidence of HCC among individuals positive for HCV alone, those positive for HBsAg alone and those positive for both was 3.0%, 2.0% and 12.0%, respectively. The age-and-sex-adjusted rate ratio was 126, 102 and 572, respectively, when those negative for both were used as a reference. The results demonstrate an increased risk for HCC among asymptomatic HCV-positive individuals in Japan. Coinfection with HBV and HCV carried a superadditive risk for HCC.
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Affiliation(s)
- Hideo Tanaka
- Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
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