Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.876
Peer-review started: October 14, 2016
First decision: December 1, 2016
Revised: December 14, 2016
Accepted: January 4, 2017
Article in press: January 4, 2017
Published online: February 7, 2017
To explore factors associated with persistent hepatitis B virus (HBV) infection in a cohort of hepatocellular carcinoma (HCC)-affected families and then investigate factors that correlate with individual viral load among hepatitis B surface antigen (HBsAg)-positive relatives.
We evaluated non-genetic factors associated with HBV replication in relatives of patients with HCC. Relatives of 355 HCC cases were interviewed using a structured questionnaire. Demographics, relationship to index case, HBsAg status of mothers and index cases were evaluated for association with the HBV persistent infection or viral load by generalized estimating equation analysis.
Among 729 relatives enrolled, parent generation (P = 0.0076), index generation (P = 0.0044), mothers positive for HBsAg (P = 0.0007), and HBsAg-positive index cases (P = 5.98 × 10-8) were associated with persistent HBV infection. Factors associated with HBV viral load were evaluated among 303 HBsAg-positive relatives. Parent generation (P = 0.0359) and sex (P = 0.0007) were independent factors associated with HBV viral load. The intra-family HBV viral load was evaluated in families clustered with HBsAg-positive siblings. An intra-family trend of similar HBV viral load was found for 27 of 46 (58.7%) families. Male offspring of HBsAg-positive mothers (P = 0.024) and older siblings were associated with high viral load.
Sex and generation play important roles on HBV viral load. Maternal birth age and nutritional changes could be the reasons of viral load difference between generations.
Core tip: Familial clustering of chronic hepatitis B infection is identified in this study. Most of the hepatitis B surface antigen (HBsAg) carriers in this cohort are in families of an HBsAg-positive index case. A high prevalence of HBsAg is found in the siblings’ generation and in offspring of an HBsAg-positive mother. The HBsAg status of index cases and HBsAg status of the mother are important factors for determining the persistence of hepatitis B virus (HBV) infection in hepatocellular carcinoma families. Sex and generation are factors associated with HBV replication. Perinatal infection has a great influence on male offspring’s HBV replication.