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Liver Int. 2015 Oct;35(10):2318-26. doi: 10.1111/liv.12814. Epub 2015 Mar 11.

Birth order and risk of hepatocellular carcinoma in chronic carriers of hepatitis B virus: a case-control study in The Gambia.

Author information

1
Medical Research Council (MRC) Unit, The Gambia, Banjul, The Gambia.
2
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
3
Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France.
4
Department of Hepatology, Imperial College London, London, UK.
5
The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, The Gambia, Banjul, The Gambia.
6
Ministry of Health and Social Welfare, Banjul, The Gambia.
7
Edward Francis Small Teaching Hospital, The Gambia, Banjul, The Gambia.
8
International Agency for Research on Cancer (IARC), Lyon, France.

Abstract

BACKGROUND & AIMS:

Early age at infection with Hepatitis B virus (HBV) increases the risk of chronic infection. Moreover, early HBV infection may further independently increase the risk of hepatocellular carcinoma (HCC) beyond its effect on chronicity.

METHODS:

The distribution of birth order, a proxy for mode and timing of HBV transmission, was compared in The Gambia between hepatitis B surface antigen (HBsAg)-positive HCC cases recruited from hospitals (n = 72) and two HBsAg-positive control groups without HCC: population-based controls from a community HBV screening (n = 392) and hospital-based controls (n = 63).

RESULTS:

HCC risk decreased with increasing birth order in the population-based case-control analysis. Using first birth order as the reference, the odds ratios were 0.52 (95% CI: 0.20-1.36), 0.52 (0.17-1.56), 0.57 (0.16-2.05) and 0.14 (0.03-0.64) for second, third, fourth and greater than fourth birth order respectively (P = 0.01). A similar inverse association was observed in the hospital-based case-control comparison (P = 0.04).

CONCLUSIONS:

Compared to controls, HCC cases had earlier birth order, a proxy for young maternal age and maternal HBV viraemia at birth. This finding suggests that in chronic HBV carriers perinatal mother-to-infant transmission may increase HCC risk more than horizontal transmission. Providing HBV vaccine within 24 h of birth to interrupt perinatal transmission might reduce the incidence of HCC in The Gambia.

KEYWORDS:

Africa; Hepatitis B; birth order; carcinoma; hepatocellular; infectious disease transmission; vertical

PMID:
25728498
DOI:
10.1111/liv.12814
[Indexed for MEDLINE]

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