Hepatitis C Virus Genotype 1b and Risk of Hepatocellular Carcinoma and high baseline AFP were the only variables independently To the Editor: correlated with the risk of developing HCC.
Thus, our prospective study, based on a larger number of We read with interest the article by Bruno et al. (p. 754), patients and events than those reported by Bruno et al., does suggesting that carriers of hepatitis C virus (HCV) genotype not indicate that HCV genotypes are determinants of HCC 1b with cirrhosis had higher risk of developing hepatocellular risk in Italian patients with cirrhosis. We have no explanacarcinoma (HCC) than similar patients with different HCV getions for these differences, although we think that studies notypes. As pointed out by the accompanying editorial, 1 molecuwith a small sample size might be biased by confoundings lar studies of HCV aimed at assessing individual risk of severe such as duration of infection and cirrhosis, which are hard liver disease, including HCC, have given conflicting results to measure in patients with community-acquired infections, worldwide. In cross-sectional studies of HCV carriers, we and and may contribute to the cohort effects mentioned. others 2,3 were unable to show any correlation between virus As a result of epidemic of hepatitis C that spread in Italy genotype and severity of disease, including HCC. In one study between 1950 and 1980 with blood transfusions and nondisposof French and Italian patients, the association between genotype able syringes, millions of people are now persistently infected 1b and advanced liver disease appeared to be a cohort effect, with genotype 1b or 2a/c, and an estimated 200,000 people attributable to the prevalence of genotype 1b among patients have HCV-related cirrhosis. 7 However, because the pattern of with longer infections. 3 A lack of correlation between HCV genomolecular epidemiology of HCV in Italy is changing as a consetype and disease severity, including HCC, was also reported quence of increasing infection with genotype 1a and 3a caused prospectively in two studies in Italy and France. 4,5 by needle-sharing among young drug users, 8 cases of cirrhosis The molecular epidemiology analysis of a cohort of paand HCC can be expected in the near future with the increasing tients with well-compensated cirrhosis who were enrolled in contribution of these genotypes. Thus, to avoid confounding a surveillance programme for HCC in 1986 offered us the caused by the changing pattern of HCV epidemiology, HCC risk opportunity of prospectively investigating the relationships in HCV carriers needs to be better assessed with approaches between HCV genotype and HCC. 6 We prospectively folother than the molecular epidemiology of HCV. lowed up 417 HCC-free patients to assess the risk of de novo appearance of HCC, with yearly measurements of serum a-RAFFAELLA ROMEO, M.D. fetoprotein (AFP) and abdominal ultrasound (US). A second-MARIA GRAZIA RUMI, M.D. generation immunoassay (Ortho Diagnostic Systems, Rari-ERSILIO DEL NINNO, M.D. tan, NJ) on serum samples that were kept frozen at 080ΠC
MASSIMO COLOMBO, M.D. showed that 280 patients were anti-HCV seropositive. Serum
Angela Maria e Antonio Migliavacca Center HCV-RNA was detected in 246 patients by nested polymerase for Liver Disease chain reaction (PCR) and typed with a hybridization assay
The FIRC-University Unit for Liver Cancer based on PCR (Innolipa, Immunogenetics, Belgium). Of IRCCS Maggiore Hospital these patients 129 (52%) had genotype 1b, 64 (26%) had 2a/ University of Milan c, 17 (7%) had 1a, and 36 (15%) had other genotypes.