Hepatitis C Virus Infection in Non-Hodgkin’s Lymphoma: A Case-Control Study

Background: Hepatitis C virus (HCV) is the most common cause of chronic liver disease in Pakistan [1]. Globally, an estimated 170 million people are infected with HCV, with approximately 3-4 million new cases each year [2][3]. Currently, the prevalence of HCV in Pakistan is 4-7% [4][5][6]. HCV is a hepatotropic virus that causes chronic hepatitis in at least 80% of infected individuals. If untreated, 20-30% of the cases will eventually develop cirrhosis, with average latency of 15-25 years, and hepatocellular carcinoma, at the rate of 1-5% per year and average latency of 20-30 years [3][7].

Objectives: We examined the association between HCV infection and non-Hodgkin\'s lymphoma (NHL).

Patients and Methods: This 2-year case control study was conducted From january 1, 2009 to december 31, 2010. A total of 292 NHL patients underwent staging, according to the Ann Arbor staging criteria, and were graded, according to the Working Formulation Classification. Anti-HCV antibodies (Abs) were used in an enzyme-linked immunosorbant assay (ELISA) to detect HCV in blood samples from the 292 NHL patients and 1168 age- and sex-matched control patients (2 groups) who met our selection criteria. The chi-square test was applied to compare anti-HCV Ab seropositivity in the cases and controls, and odds ratio values were computed. The NHL patients were divided into anti-HCV Ab seronegative and seropositive groups to compare the effect of anti-HCV Ab seropositivity on NHL stages and grades. A P value of 0.05 was considered statistically significant.

Results: A total of 52 (17.8%) cases, including 45 (7.7%) controls in group 1 (1st degree relatives) and 50 (8.6%) controls in group 2 (non-hematological malignancy), showed positive results for anti-HCV Abs and had a odds ratio value of 2.59 (95% CI: 1.69-3.97) for group 1 and 2.31 (95% CI: 1.52-3.50) for group 2 (P value of 0.000 for both groups). NHL patients who showed positive results for anti-HCV Abs were likely to be middle-aged patients (40-60 years; odds ratio, 3.68; 95%CI: 2.07-6.50). Anti-HCV Ab seropositivity did not significantly affect the grades and stages of NHL.

Conclusions: NHL is strongly associated with anti-HCV Ab seropositivity (odds risk, 2-2.5), and seropositive cases were generally middle-aged and younger patients.