IJE Advance Access originally published online on May 20, 2004
International Journal of Epidemiology 2004 33(5):1034-1039; doi:10.1093/ije/dyh183
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IJE vol.33 no.5 © International Epidemiological Association 2004; all rights reserved.
Article |
Case-control study of non-Hodgkin's lymphoma and hepatitis C virus infection in Egypt
1 Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
2 Georgetown University, Lombardi Cancer Center
3 Cairo University, Egyptian National Cancer Institute
4 University of Maryland, Department of Epidemiology and Preventive Medicine
5 Minia University, Department of Microbiology
Correspondence: Christopher A Loffredo, Georgetown University, Box 571472, Washington DC 20057-1472, USA. E-mail: CAL9{at}georgetown.edu
Background Chronic infection with hepatitis C virus (HCV) has been associated in some studies with increased risk for B-cell non-Hodgkin's lymphoma (NHL). To assess this further, we conducted a case-control study in Egypt, where HCV prevalence is extremely high.
Methods Cases with B-cell NHL (N = 227) were recruited from the National Cancer Institute of Cairo University, a major referral centre. Controls (N = 227) were patients with fractures being treated at the Kasr El-Aini Orthopaedic Hospital, from the same referral base as the cases, and were frequency-matched by gender, rural versus urban birthplace, and age. Subjects were interviewed about their medical history and possible risk factors, and blood samples were collected for HCV diagnostic tests. Anti-HCV and HCV RNA were determined by enzyme-linked immunoassay and reverse transcription-polymerase chain reaction, respectively. Odds ratios (OR) and 95% CI were calculated from logistic regression models.
Results Overall, 42% of subjects were anti-HCV positive and 33% had HCV RNA. There was a statistically significant unadjusted association of HCV RNA with NHL (OR = 2.3, 95% CI: 1.5, 3.5), which differed slightly by gender (males: OR = 2.1, 95% CI: 1.2, 3.7 versus females: OR = 2.5, 95% CI: 1.3, 4.8). Anti-HCV without HCV RNA was not associated with case status (OR = 0.9, 95% CI: 0.5, 1.6). After adjustment for age, gender, rural versus urban birthplace, and rural versus urban current residence, the association of HCV RNA with the risk of NHL remained statistically significant (OR = 2.9, 95% CI: 1.9, 4.5).
Conclusions These data support the hypothesis that NHL is a malignant outcome of chronic HCV infection.
Keywords Hepatitis C, lymphoma, non-Hodgkin, Egypt, case-control studies
Accepted 24 February 2004
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