Helicobacter Infection in Patients with HCV-Related Chronic Hepatitis, Cirrhosis, and Hepatocellular Carcinoma MARIA P. DORE, MD, PhD,* GIUSEPPE REALDI, MD,* DANIELA MURA, MD,* DAVID Y. GRAHAM, MD,† and ANTONIA R. SEPULVEDA, MD, PhD‡ Chronic hepatitis may progress to cirrhosis and hepatocellular carcinoma (HCC). HCC represents one of the most common human cancers. Incidence rates for this tumor vary widely on a worldwide, suggesting that environmental factors such as infectious microorgan- isms, carcinogens, or nutrition play a role in its pathogenesis. Several Helicobacter spp. colonize the liver of animals and induce hepatitis. The aim of this study was to determine whether Helicobacter infection was associated with HCV-related liver diseases in humans. Liver tissue samples, including biopsy and surgically excised tissues, were collected from patients positive for hepatitis C viruses (HCV) RNA in the serum. Genomic DNA was extracted from sections of formalin-fixed paraffin-embedded tissues by using the QIAamp Tissue Kit and subjected to polymerase chain reaction (PCR) analysis using two sets of Helicobacter-specific 16S ribosomal RNA primers. To identify positive samples for H. pylori, a set of primers specific for a conserved region in the H. pylori vacA gene were also used. The patients’ H. pylori status was determined by ELISA. Forty-one patients (mean age 54.9, range 19 –78 years; 24 men) were studied. Thirty patients had chronic viral hepatitis (CH) without ( N  18) or with ( N  12) cirrhosis (CIR), and 11 patients had HCC. Anti-H. pylori IgG was detected in 54%. The expected 422- and 210-bp fragments of Helicobacter 16S rRNA were amplified from 27% of liver samples, including 17% of CH-CIR and 55% of HCC ( P  0.004). The vacA sequence was amplified in 10 of 41(24%) samples (27% of those with HCC). These data confirm the presence of H. pylori DNA sequences in human liver and suggest an association of Helicobacter spp. with HCV-related chronic liver diseases. Further studies are needed to ascertain whether Helicobacter spp. infection plays a role in the development of HCC. KEY WORDS: Helicobacter; hepatitis C virus; cirrhosis; chronic liver diseases. Primary hepatocellular carcinoma (HCC) results in between 250,000 and one million deaths annually (1). HCC is one of the most common human cancers. The incidence of HCC varies widely according to geo- Manuscript received June 20, 2001; accepted November 14, 2001. From the *Institute of Internal Medicine, University of Sassari, Italy; †Departments of Medicine, VAMC and Baylor College of Medicine, Houston, Texas; and ‡Department of Pathology Univer- sity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. This work was supported by the Department of Veterans Affairs, by the generous support of Hilda Schwartz, Houston, Texas, and by the Institute of Clinica Medica, University of Medicine, Sassari, Italy. Address for reprint requests: Dr. Maria Pina Dore, Istituto di Clinica Medica, Universita di Sassari, Viale San Pietro, 8, Sassari 07100, Italy. Digestive Diseases and Sciences, Vol. 47, No. 7 (July 2002), pp. 1638 –1643 (© 2002) 1638 Digestive Diseases and Sciences, Vol. 47, No. 7 (July 2002) 0163-2116/02/0700-1638/0 © 2002 Plenum Publishing Corporation