USMLE Forums - View Single Post - HCC related with which Hep virus???
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Old 04-27-2010
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ath.pantelis ath.pantelis is offline
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I remember myself having mistaken a similar question during my preparation, based on the fact that epidemiologically an individual is most probable to be infected by HBV rather than HCV. This is not a correct working hypothesis, though...

First of all, any cause that leads to cirrhosis may lead to HCC as well (including viruses, hemochromatosis, Wilson's disease, alcohol etc). HCC is in a way the natural course of a continuous process of inflammation and tissue regeneration, which statistically may lead to the arising of a clone of cells capable of not undergoing normal apoptosis (or not staying in the G0 phase of the cell cycle, as resting liver cells normally do). So, this would not be a criterion to tell HBV & HCV infections apart.

Another important point is that HCV classically presents with waxing & waning transaminase levels but subliminal symptomatology. Arthralgias, myalgias, cryoglobulinemia & glomerulonephritis may all be present, but these are constitutional, non-specific symptoms.

Following the above data, a case of HCV may evolve subclinically and well evade diagnosis until it presents as HCC. On the contrary, HBV should typically undergo the "stage of clinically evident cirrhosis", before it manifests as HCC.

Another reason could be that HBV causes chronic infection only in approx. 5-10% of infected patients, versus >80% related to HCV. On statistical grounds again, among those 5-10% patients few will develop HCC, which is not the case for the 80% of HCV patients.

Hope this helps...
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