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Cancer Epidemiol Biomarkers Prev. 2019 Aug 13. doi: 10.1158/1055-9965.EPI-19-0023. [Epub ahead of print]

Herbal Medicine Containing Aristolochic Acid and the Risk of Primary Liver Cancer in Patients with Hepatitis C Virus Infection.

Chen CJ#1, Yang YH#2,3,4,5, Lin MH4, Lee CP4, Tsan YT6,7, Lai MN8, Yang HY2,9,10, Doyle P11, Ho WC12, Chen PC13,9,10,14,15.

Author information

1
Graduate Institute of Data Science, Taipei Medical University, Taipei, Taiwan.
2
Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.
3
Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan.
4
Health Informatics and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi County, Taiwan.
5
School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
6
Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
7
School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
8
Department of Statistics, Feng Chia University, Taichung, Taiwan.
9
Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
10
Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
11
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
12
Department of Public Health, China Medical University, Taichung, Taiwan. pchen@ntu.edu.tw wcho@mail.cmu.edu.tw.
13
Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan. pchen@ntu.edu.tw wcho@mail.cmu.edu.tw.
14
Innovation and Policy Centre for Population Health and Sustainable Environment, National Taiwan University College of Public Health, Taipei, Taiwan.
15
Office of Occupational Safety and Health, National Taiwan University Hospital, Taipei, Taiwan.
#
Contributed equally

Abstract

BACKGROUND:

We investigated the association between taking herbal medicine (HM) containing aristolochic acid (AA) and the risk of primary liver cancer (PLC) among patients with hepatitis C virus (HCV) infection.

METHODS:

This is a prospective study for the long-term follow-up of a nationwide population-based cohort of patients ages 18 years or older diagnosed with HCV infection during 1997 to 2010. A total of 223,467 HCV-infected patients were identified using the National Health Insurance Research Database in Taiwan. The use of HM containing AA was evaluated among patients who had visited traditional Chinese medicine clinics beginning from 1997 to 1 year prior to the diagnosis of PLC or dates censored (2003). We tracked each individual patient from 1997 to 2013 to identify incident cases of PLC since 1999.

RESULTS:

During the follow-up period of 3,052,132 person-years, we identified 25,502 PLC cases; this corresponded to an overall incidence rate of 835.5 PLCs per 100,000 person-years. The adjusted HRs were 1.21 [95% confidence interval (CI), 1.18-1.24], 1.48 (95% CI, 1.37-1.59), 1.50 (95% CI, 1.34-1.68), and 1.88 (95% CI, 1.61-2.19) for estimated AA usage groups: 1 to 250, 251 to 500, 501 to 1,000, and more than 1,000 mg, respectively, relative to no AA exposure (reference group).

CONCLUSIONS:

The current findings suggest that among HCV-positive patients, increasing exposure to AA poses an increased risk of acquiring PLC.

IMPACT:

AA may increase the risk of PLC in HCV-positive populations.

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