Evidence-based Medicine: Time for a change? - Journal of Medical ...

ORIGINAL ARTICLE
associated risk factors like HIV-HCV and HIV-
HBV-HCV over and above alcoholic liver
disease is an unique finding of this Northeastern
state of India.
There were 20 cases of HCC (15.15%)
amongst the 132 CLD cases and 9 of
61(14.75%) chronic HCV. Out of the 20 HCC
cases, 9 were associated with HCV (45%).
Other associated risk factors found in these
9 HCC cases were HIV-HCV (2 cases), HCV-
HBV-HIV (1 case) and HCV cirrhosis with
chronic alcoholic (6 cases). Other studies by
Olubuyide et al in Ibadan, Kirk et al in West
Africa and Kew in his study among blacks in
Southern Africa found HCV infection in
18.7%,19%, 13.2% and 19.5% of their
patients with HCC respectively. 19,20,21 These
studies show lower percentage of HCV
associated HCC cases than the present
study. However, Chen in his study among
natives in Taiwan, found that 70-80% of his
patients with HCC had evidence of HCV
infection. 22 Similarly, Tanaka et al found that
78% of Japanese patients with HCC had
evidence of HCV infection. 23 The higher
prevalence of HCV associated HCC (45%) in
the present study may be because of high
prevalence of IDU and sexually transmitted
HIV which shares similar route of
transmission.
Three (3) of the 11 cases (27.27%) of chronic
HBV was found to be associated with HCC.
In a prospective study conducted by Yang HI
et al, the relative risk of HCC was 9.6 among
men who were positive for HBsAg alone and
60.2 among those who were positive for both
HBsAg and HBeAg, as compared with men
who were negative for both. 24 In the present
study, 15% of the total HCC cases were
associated with chronic HBV which include
both HBeAg positive as well as negative
cases. In Manipur AIDS Control Organisation
report also, HBV coinfection with HIV is much
lower than that of HCV though the real cause
is not known so far.
Four (4) of 67 chronic alcoholic cases (5.97%)
were associated with HCC. Associated risk
factors with chronic alcoholism were chronic
smoking (46%), multiple sexual partner (36%),
and occasional sexual relational relationship
(20%)
Presence of 31(23.48%) cases of HIV, HIV-
HCV, HIV-HBV-HCV among 132 cases of CLD
shows that there are multiple infections
among CLD with or without HCC which can
be an eye opener for the health care workers
and the importance of prevention of these viral
infections. Thus routine screening of HIV, HBV
and HCV are important while managing CLD
cases. The high prevalence of HCC amongst
chronic HCV calls for the need of HCC
screening among chronic HCV patients with
nodular liver.
Conclusion: The present study shows that
the commonest risk factors for CLD are
chronic alcoholism, (50.75%) and chronic
HCV (46.21%). There were 20 (15.16%) cases
of HCC. The most commonly associated risk
factors for HCC are Chronic HCV (45%) with
or without co-infection, chronic alcoholism
(30%), etc.
The limitations of the present study are small
sample size, unvailability of facilities for HBV/
HCV genotyping and viral load and liver biopsy.
A larger study with adequate sample size is
needed to give us more insight about the
clinical profile of Chronic liver disease with
reference to hepatocellular Carcinoma in
Manipur.
Reference:
1. Yu MH, Chang HC, Liaw YF, Lin SM, Lee
SD, Liu CJ. Familial Risk of
Hepatocellular Carcinoma among
Chronic Hepatitis B Carriers and Their
Relatives. J natl cancer Inst 2000 Jul 19;
92(14):1159.
2. Sherlock S, Dooley J. Hepatic
transplantation. In: Sherlock S, Dooley
J, editors. Diseases of the liver and biliary
system. 11 th ed. London: Blackwell
Science; 2002. p. 657-76.
3. Carr BI. Tumors of the biliary tree. In:
Fauci AS, Kasper DL, Longo DL,
Braunwald E, Hauser SL, Jameson JL,
editors. Harrison’s principles of internal
medicine. 17 th ed. New York: McGraw
Hill; 2008. p. 581-82.
18 JMS * JMS Vol 25 * Vol * No. 25 3 * No. * September, 1 * June, 2010 2011