Hepatitis B-related sequelae: prospective study in 1400 hepatitis B surface antigen-positive Alaska native carriers

Individuals who chronically carry the hepatitis B virus, as indicated by the presence of hepatitis B surface antigen, are at increased risk for liver cancer, cirrhosis, and active hepatitis. The mechanisms by which the virus produces active disease are uncertain. Attempts to identify individuals carrying hepatitis B virus revealed that there is a high prevalence of hepatitis B surface antigen among some subgroups of native Americans in Alaska. These natives, who may be Eskimos, Indians, or Aleuts, were screened for conditions related to hepatitis B infection. A total of 1,400 individuals were followed for a total of 7,815 carrier-years. Twenty cases of hepatocellular carcinoma, a liver cancer, 14 cases of active hepatitis, and eight cases of cirrhosis were identified and confirmed by biopsy. These results translate into an annual incidence for hepatocellular carcinoma of 387 per 100,000 men and 63 per 100,000 women; the incidence of active hepatitis was 193 per 100,000 men and 158 per 100,000 women; and the incidence of cirrhosis was 107 per 100,000 men and 95 per 100,000 women. During the study period, 60 individuals died; thirteen of these deaths were due to liver cancer. This makes liver cancer the leading cause of death of those positive for hepatitis B surface antigen. This contrasts with the rest of the Alaskan native population, for whom accidents are the leading cause of death. (Consumer Summary produced by Reliance Medical Information, Inc.)