Aflatoxin B1 exposure increases the risk of cirrhosis and hepatocellular carcinoma in chronic hepatitis B virus carriers
Menée à Taïwan à partir de données portant sur des patients atteints d'une hépatite B chronique, cette étude évalue l'association entre les niveaux sériques d'aflatoxine B1, une mycotoxine présente dans divers aliments, et le risque de cirrhose et de carcinome hépatocellulaire (232 cas de cirrhose, 262 cas de carcinome hépatocellulaire, 577 témoins)
The relation between aflatoxin B1 (AFB1) and cirrhosis in chronic carriers of hepatitis B virus (HBV) remains inconclusive. This case-control study nested in a large community-based cohort aimed to assess the effect of AFB1 exposure on cirrhosis and HCC in chronic HBV carriers. Serum AFB1-albumin adduct levels at study entry were measured in 232 cirrhosis cases, 262 HCC cases and 577 controls. Multivariate-adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression. Among all chronic HBV carriers, the time intervals between study entry and diagnosis of HCC, cirrhosis, cirrhotic HCC, and non-cirrhotic HCC were all significantly (p < 0.0001) shorter in participants with high serum levels of AFB1-albumin adducts than those with low/undetectable levels. There were significant dose-response relations with serum AFB1-albumin adduct level at study entry for cirrhosis (p-trend = 0.0001) and cirrhotic HCC (p-trend < 0.0001) newly diagnosed within 9 years after entry as well as non-cirrhotic HCC (p-trend = 0.021) newly diagnosed within 4 years after entry. The aORs (95% CIs) for high versus undetectable serum AFB1-albumin adduct levels were 2.45 (1.51–3.98) for cirrhosis (p = 0.0003), 5.47 (2.20–13.63) for cirrhotic HCC (p = 0.0003), and 5.39 (1.11–26.18) for non-cirrhotic (p = 0.0368) HCC, respectively. There remained a significant dose-response relation between serum AFB1-albumin adduct level and HCC risk (p-trend = 0.0291) in cirrhosis patients, showing an aOR (95% CI) of 3.04 (1.11–8.30) for high versus undetectable serum levels (p = 0.0299). It is concluded that AFB1 exposure may increase the risk of cirrhosis and HCC in a dose-response manner among chronic HBV carriers.