Establishment of a viral hepatitis surveillance system--Pakistan, 2009-2011

Hepatitis A is thought to infect almost all persons living in Pakistan by age 15 years, and hepatitis E is responsible for sporadic infections and outbreaks. The prevalence of hepatitis B virus (HBV) infection is estimated at 2.5% and the prevalence of hepatitis C virus (HCV) infection, estimated at 4.8%, is one of the highest rates in the world. Hepatitis surveillance in Pakistan has been syndromic, failing to confirm infection, distinguish among viruses, or collect information on risk factors. To understand the epidemiology of viral hepatitis in Pakistan more clearly, the Ministry of Health (MOH) asked the Pakistan Field Epidemiology and Laboratory Training Program (FELTP) to establish a hepatitis sentinel surveillance system in five large public hospitals in four provinces and Islamabad Capital Territory. This report describes the implementation of the viral hepatitis surveillance system in Pakistan and summarizes major findings from June 2010 through March 2011. A total of 712 cases of viral hepatitis were reported; newly reported HCV infection accounted for 53.2% of reported cases, followed by acute hepatitis A (19.8%), acute hepatitis E (12.2%), and newly reported HBV infection (10.8%). A history of health-care--related exposures, particularly receipt of therapeutic injections and infusions, commonly were reported by persons infected with HBV and HCV, and most patients reported drinking unboiled water. These findings point to the need for improved provider and community education about risks associated with unsafe injections, strengthening infection control practices in health facilities, increasing hepatitis B vaccination coverage, and improving access to clean drinking water in Pakistan.     

乙型和丙型病毒性肝炎及相关肝细胞癌的流行现况

乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染是全球主要的健康问题。全球约有3.5亿人（5%）为HBV慢性感染者,其中75%为亚洲人,而HCV的慢性感染者为1.5亿人（2%）。乙型和丙型肝炎是肝硬化和肝细胞癌（HCC）的主要危险因素,肝硬化中的57%和原发性肝癌中的78%为HBV或HCV感染引起。作者将中国、亚洲和美国的HBV、HCV和HCC的流行病学资料进行综述比较,并分析当前危险因素等。在中国和全球其他国家,HBV和HCV仍是HCC的主要危险因素,HBV疫苗的使用显著降低了HBV感染率,进而降低了HCC的患病率,而将来HCV可能取代HBV成为主要危险因素;乙醇作为肝硬化和肝癌的危险因素影响较小。     

Hepatitis B and C virus infections in Turkish children with cancer

In this study, we tested 137 Turkish children with cancer (51 with acute leukemia, 48 with lymphoma, 38 with solid tumors) while they were undergoing chemotherapy, and a control group of 45 for evidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections using the enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR). The control group included children with other disease who had applied to the outpatient clinic during the study period and had no history of jaundice or transfusion. Sixty-five (47.4%) patients with cancer and 7 (20%) children in the control group were positive for hepatitis B surface antigen (HBsAg) (p < 0.01). HBV DNA was detected in 59 (43.1%) patients and in 9 (20%) controls (p < 0.01). HCV specific antibody (anti-HCV) was detected in 8 (5.8%) patients and in 1 (2.2%) control (p > 0.05). Eight patients (5.8%) had circulating HCV RNA, but none had in the control group (p = 0.09). Ten (13.9%) of the 72 patients who were negative for HBsAg had circulating HBV DNA, and 7 (5.4%) of the 129 patients who were negative for anti-HCV had circulating HCV RNA. We concluded that HBV and HCV infections are common among Turkish children with cancer. In countries where HBV infection is widespread among the general population as in Turkey, children with cancer are under greater risk for HBV infection.     

Prevalence,risk factors and evaluation of a screening strategy for chronic hepatitis C and B virus infections in healthy company employees

A cross-sectional study was carried out in employees of 17 Greek companies with the aim of assessing the prevalence of hepatitis B (HBV) and hepatitis C (HCV) virus, identifying associated prognostic/risk factors and evaluating the effectiveness of a questionnaire as a pre-screening tool. All participants were asked to complete a questionnaire and a random sample of them was asked to provide a blood sample for hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C (anti-HCV) testing. Individual questions or combinations of them were evaluated in terms of their ability to detect HBV or HCV(+) cases. Of 9085 eligible employees, 6074 (67%) completed the questionnaire. Of 990 samples obtained, 19.9% were anti-HBc(+), 2.6% HBsAg(+) and 0.5% anti-HCV(+). All anti-HCV(+) cases had multiple parenteral risk factors. Multiple logistic regression identified associations between anti-HBc and older age, family members with chronic hepatitis, job category and history of transfusion before 1992. HBsAg(+) was associated with older age and history of transfusion before 1992. None of the risk/prognostic factors had sufficient sensitivity and specificity for HBV but report of at least one risk factor identified all HCV(+) cases. Anti-HCV screening of those with at least two parenteral risk factors not only identified all anti-HCV(+) cases but also resulted in 86% decrease in the screening cost. Under the light of recent treatment advances, targeted questionnaire-based screening of asymptomatic people may prove to be a cost-effective way to face hepatitis C.     

Multiple infections and associated risk factors among non-injecting cocaine users in Argentina

The aim of this study was to estimate the seroprevalence rates of human immunodeficiency virus (HIV), hepatitis B virus (HBV, core antibody), hepatitis C virus (HCV), and syphilis infections and analyze associated risk factors among 504 non-injecting cocaine users (NICU) in Buenos Aires, Argentina. Participants were interviewed in face-to-face sessions through a short structured questionnaire. Using venipuncture, 10 mL of blood was collected. Seroprevalence rates were: HIV (6.3%), HBV (9%), HCV (7.5%), and VDRL (4.2%). The risk of being infected with HIV, HBV, and HCV was significantly associated with having had a sex partner who was either a drug injector or who was known to be HIV positive. HIV and HCV infections were associated with former imprisonment, and HCV was associated with having been tattooed. Because of the rising number of NICU and the multiple infections detected, it is essential to implement prevention strategies focused on this population.     

Injections in health care settings: a risk factor for acute hepatitis B virus infection in Karachi,Pakistan

A case control study was conducted to identify the association of therapeutic injections with acute hepatitis B virus (HBV) infection in Karachi, Pakistan. We enrolled 67 cases of acute HBV infection (IgM anti-HBc positive) and 247 controls (anti-HBc negative) from four hospitals of Karachi during July 2000-June 2001. Exposure to various risk factors during the period relevant to the incubation period of HBV was recorded both from cases and controls using a structured questionnaire. Multivariate logistic regression analysis of the data showed that cases were more likely to have received one injection (OR = 4.0; 95 % CI 1.4, 11.1), or more than one injection (OR = 6.3; 95 % CI 3.2, 12.4) compared to controls. The estimated population attributable risk (PAR) for therapeutic injections was 53%. Also the cases compared to controls were more likely to have household size of seven or more (OR = 1.9; 95 % CI 0.95, 3.9). This study showed that unsafe therapeutic injections appear to be the major risk factor for acute HBV infection and needs immediate focus from public health stand point.     

Case-reporting of acute hepatitis B and C among injection drug users

Although public health surveillance system data are widely used to describe the epidemiology of communicable disease, occurrence of hepatitis B and C virus (HBV and HCV, respectively) infections may be misrepresented by under-reporting in injection drug users (IDUs). This study was carried out to examine the relationship between HBV and HCV incidence and case-reporting of hepatitis B and C in Seattle IDUs. Names of participants in a Seattle IDU cohort study who acquired HBV or HCV infection over a 12-month follow-up period were compared to a database of persons with acute bepatitis B and C reported to the bealth department surveillance unit over the same period. Of 2,208 IDUs enrolled in the cohort who completed a follow-up visit, 63/759 acquired HBV infection, 53/317 acquired HCV infection, and 3 subjects acquired both HBV and HCV. Of 113 cohort subjects who acquired HBV or HCV, only 2 (1.5%) cases were reported; both bad acute bepatitis B. The upper 95% confidence limit for case-reporting of bepatitis C in the cohort was 5.7%, and for hepatitis B, it was 7.5%. In this study, reporting of acute bepatitis in IDUs was extremely low, raising questions regarding the use of community surveillance data to estimate underlying incidence in that population group.     

Prevalence of hepatitis B markers in patients with hepatitis C infection in north-eastern Poland: Risk factors and vaccine use

We evaluated the prevalence of hepatitis B virus (HBV) markers and established HBV vaccination status among 111 patients with hepatitis C virus (HCV) infection. A history of HBV immunisation was recorded in 30 patients (27.0%) and only 17/30 (66.7%) had anti-HBs level 10 mIU/ml. All patients were HBsAg-negative and 22.2% of nonvaccinated subjects had evidence of HBV infection as determined by anti-HBc presence. Among patients with anti-HBc in 7/18 cases (38.9%) anti-HBc was the only marker of HBV infection (without anti-HBs). The prevalence of anti-HBc was significantly higher among patients who reported a history of acute hepatitis. In conclusion the prevalence of HBV markers in patients with HCV infection in north-eastern Poland is similar to the prevalence in general population, which suggests no increased risk for nosocomial HBV infection among those individuals. HCV infection seems to favour unusual serological pattern of HBV infection with anti-HBc as the only marker. HBV vaccine use is low among patients with HCV infection in north-eastern Poland.     

娄底市吸毒人群HIV、HBV、HCV、梅毒感染状况及影响因素分析

目的了解娄底市吸毒人群HIV、HBV、HCV、梅毒感染状况及影响因素,为吸毒人群中这几种疾病的综合防治提供依据。方法对娄底市戒毒所戒毒人员面对面进行匿名问卷调查,并采集静脉血进行HIV、HBV、HCV和梅毒血清学检测。结果182名吸毒人员中,HIV抗体阳性1例,阳性率为0.55%、HBsAg阳性24例,阳性率为13.19%、HCV抗体阳性92例,阳性率为50.55%、梅毒抗体阳性12例、阳性率为6.59%,合并感染HIV/HCV1例,占0.55%,合并感染HBV/HCV12例,占6.59%,合并感染梅毒/HCV7例,占3.85%。结论该市吸毒人群中HCV、梅毒感染率较高,与他们的多性伴和注射毒品行为有关,应积极开展针对性地干预措施。     

Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses through unsafe injections in the developing world: model-based regional estimates

Thousands of millions of injections are delivered every year in developing countries, many of them unsafe, and the transmission of certain bloodborne pathogens via this route is thought to be a major public health problem. In this article we report global and regional estimates of the number of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections that may occur from unsafe injections in the developing world. The estimates were determined using quantitative data on unsafe injection practices, transmission efficiency and disease burden of HBV, HCV and HIV and the prevalence of injection use obtained from a review of the literature. A simple mass-action model was used consisting of a generalized linear equation with variables accounting for the prevalence of a pathogen in a population, susceptibility of a population, transmission efficiency of the pathogen, proportion of injections that are unsafe, and the number of injections received. The model was applied to world census data to generate conservative estimates of incidence of transmission of bloodborne pathogens that may be attributable to unsafe injections. The model suggests that approximately 8-16 million HBV, 2.3-4.7 million HCV and 80,000-160,000 HIV infections may result every year from unsafe injections. The estimated range for HBV infections is in accordance with several epidemiological studies that attributed at least 20% of all new HBV infections to unsafe injections in developing countries. Our results suggest that unsafe injections may lead to a high number of infections with bloodborne pathogens. A major initiative is therefore needed to improve injection safety and decrease injection overuse in many countries.     

Occult Hepatitis B Infection in the Immigrant Population of Sicily, Italy

In Italy, about 7 % of the resident population is represented by immigrants originating from geographic regions at high endemicity for hepatitis B virus infection. This study aims to assess the prevalence of occult HBV infection (OBI) including the identification of HBV-genotypes in a population of immigrants serologically negative for hepatitis B surface antigen (HBsAg). Between May 2006 and May 2010, 339 immigrants were tested for markers of HBV, hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. HBV-DNA was tested by using nested-PCR assays on three different genetic region. HBV-DNA was detected in plasma samples of 11/339 (3.2 %) patients. Most of them had no serological markers of HBV infection, 3/58 (5.2 %) were anti-HBc-alone, and 4/13 (30.8 %) were anti-HIV positive. HIV positivity was the only factor independently associated with the higher probability of observing OBI (OR = 16.5, p < 0.001). No HCV co-infected patients were found. Genotype D was detected in 9/11 (81.8 %) OBI cases, while the remaining two (18.2 %) were classified as genotype E. Although OBI was found at lower rate than expected among immigrants from highly endemic countries, anti-HBc alone positivity was confirmed as a sentinel marker of occult HBV infection. Nevertheless, a marked heterogeneity of HBV markers was found among HBV-DNA positive subjects. Our finding evidenced the predominance of HBV-genotype D viral strains among OBI cases, also in those from geographical areas where overt HBV infections are mainly sustained by viral genotypes other than D.     

Seroprevalence of markers for hepatitis B, C and G in male and female prisoners - NSW, 1996

OBJECTIVES: 1. Establish the prevalence of markers for hepatitis B (HBV), C (HCV) and G (HGV) in a sample of male and female inmates. 2. Examine exposure to multiple viruses. 3. Compare risk factors for HGV infection with known risk factors for HBV and HCV. DESIGN: Cross-sectional random sample stratified by sex, age and Aboriginality. Inmates were screened for three hepatitis markers. Participants were 789 inmates (657 male, 132 female) in 27 correctional centres in New South Wales, 1996. RESULTS: Overall detection of each of the three screening markers was 35% for HBV, 39% for HCV and 10% for HGV. Exposure rates were higher in female prisoners than males. Increased rates of anti-HBc were observed in Aboriginal inmates compared with non-Aboriginals (54% cf. 27%); anti-HCV and HGV-RNA were comparable between the two groups (36% cf. 41% and 9% cf. 10%). Markers were significantly higher in female injecting drug users (IDU), particularly HCV (90% cf. 66%). Thirty-five per cent of inmates were unaware of their HCV status. For HBV, 72% did not self-report past or present exposure despite serological evidence to the contrary. The multivariate analysis identified Aboriginality, long-term injecting and injecting while in prison as risk factors for HBV. HCV risk factors were female sex, non-Aboriginality, institutionalisation and IDU-associated behaviours. For HGV, female sex and previous imprisonment were significant risk factors but IDU was not. CONCLUSIONS: Blood-borne hepatitis viruses are common in prison inmates, particularly females (HBV, HCV and HGV), Aboriginals (HBV) and IDU (HBV and HCV). Infection can be related to a number of risk factors, which appear similar for HBV and HCV, but distinct from HGV.     

The role of hepatitis B and hepatitis C viral infections in the incidence of hepatocellular carcinoma in Sudan.

In Sudan, the incidence of hepatocellular carcinoma (HCC) is high and increasing. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are important risk factors of HCC. This study aims to assess the role of HBV and HCV infections in the incidence of HCC in 2 regions of Sudan. A case-control study was conducted in 1996-98 among 150 HCC patients and 205 controls from 2 regions in Sudan. Their demographic characteristics as well as food habits and chronic conditions have been investigated. In this study, 115 cases and 199 controls were tested for hepatitis B surface antigen (HBsAg) and for HCV antibodies. Strong positive associations were found between HBV or HCV, and HCC with odds ratios (ORs) 9.8 (95% CI 5.1-18.9) and 8.3 (95% CI 2.3-29.9), respectively. After adjustment for age, by logistic regression, the ORs for HBV and HCV were 16.1 (95% CI 7.4-34.9) and 4.5 (95% CI 1.1-18.6), respectively. Further adjustment for region, education level and job type did not appreciably affect the results. Given a prevalence of HBV and HCV of 7.0% and 1.5% among controls, about 57% of all HCC cases can be attributed to these viral infections. Hepatitis infections seem to be important risk factors for HCC in Sudan.     

Association between heroin use, needle sharing and tattoos received in prison with hepatitis B and C positivity among street-recruited injecting drug users in New Mexico, USA.

This study aimed to assess the seroprevalence and risk factors for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV-1 infections among injecting drug users (IDU) in New Mexico. Serological and behavioural surveys were conducted in conjunction with street-based outreach, education and HIV counselling and testing. High rates of antibody positivity for HCV (82.2%) and HBV (61.1%), and a low rate for HIV (0.5%) were found. In multivariate analyses, both HBV and HCV infection were positively associated with increasing age, increasing years of injection and heroin use. Receipt of a tattoo in prison/jail was associated with HBV (odds ratio = 2.3, 95% confidence interval 1.4, 3.8) and HCV (OR = 3.4, 95% CI = 1.6, 7.5) infections. Prevention of bloodborne pathogens among IDUs should focus on young users, early in their drug use experience. Studies examining the relationship between tattooing and HBV and HCV infection are needed as are efforts to promote sterile tattooing, in prisons and elsewhere.     

温州地区艾滋病感染者和病人合并感染乙肝、丙肝、梅毒等疾病的研究

目的:研究艾滋病感染者和病人(HIV/AIDS)合并感染乙型病毒性肝炎(HBV)、丙型病毒性肝炎(HCV)、梅毒(TP)的流行现状及其特点,为HIV/AIDS的防控和治疗提供科学依据。方法:选取2008年-2010年期间在温州实验室确认阳性的艾滋病感染者和病人的标本共678例,采用ELISA法,分别对标本进行乙肝表面抗原、丙肝抗体、梅毒抗体项目检测。结果:其中,合并感染乙肝的有102例(15.04%),感染丙肝84例(12.38%),感染梅毒145例(21.38%);同时感染乙肝、丙肝的有13例(1.91%),感染乙肝、梅毒有31例(4.57%),感染丙肝、梅毒的有13例(1.91%),同时感染乙肝、丙肝、梅毒的2例(0.29%)。结论:1、HIV感染者中HBV感染率略高于普通人群;HIV与HCV合并感染率显著高于普通人群,但低于国内外报道的HIV/HCV的30%以上;HIV与TP合并感染的比例显著高于普通人群以及其他地区艾滋病患者。2、合并感染的总体趋势有所控制。     

A large nosocomial outbreak of hepatitis C and hepatitis B among patients receiving pain remediation treatments.

BACKGROUND AND OBJECTIVE: In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak's extent and etiology. DESIGN, SETTING, AND PARTICIPANTS: We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection. RESULTS: Of 908 patients, 795 (87.6%) were tested, and 71 HCV-infected patients (8.9%) and 31 HBV-infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV-infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4-15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3-6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe-needle to sequentially administer sedation medications to every treated patient each clinic day. CONCLUSIONS: Reuse of needles-syringes was the mechanism for patient-to-patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.     

Hepatitis B and C among Berlin dental personnel: incidence, risk factors, and effectiveness of barrier prevention measures

A study of 215 Berlin dentists and 108 dental assistants recruited at the 1997 Berlin Dental Society meeting assessed their occupational risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. HBV vaccine coverage, and barrier prevention methods used. Among dentists, 7% (95% CI 4-11) and 0.5% (95% CI 0-3) had serological evidence of previous HBV and HCV infection, respectively. Similar figures for dental assistants were 1% (95% CI 0-5) and 0% (95% CI 0-4). Only 74% of dentists and 63% of dental assistants reported HBV vaccination. Approximately half always used gloves, eye glasses, or face masks. HBV unvaccinated dentists whose patients had HBV risk factors had a greater risk of HBV infection; those who always wore face masks were at lower risk (OR 0.2, 95% CI 0.02-0.98). These data indicate that among Berlin dentists, the HCV risk was lower than that of HBV and that face masks may have lowered the risk of HBV. The use of eye glasses or gloves did not appear to lower the risk of HBV acquisition in this population.     

A ten year serological survey of hepatitis A, B and C viruses infections in Nepal

BACKGROUND: In 1987, we reported that the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in Nepal was low, as compared to hepatitis A virus (HAV) infection, and that no human T-lymphotropic type-1 (HTLV-1) infection was found in Nepal. OBJECTIVES: To determine changes in the prevalence of HAV, HBV, and HCV infections between 1987 and 1996 in inhabitants of Bhadrakali (suburban) and Kotyang (rural) villages in Nepal. STUDY DESIGN: We did a cross-sectional survey of 458 inhabitants of two Nepalese villages, to assess the prevalence of antibody to HAV (anti-HAV), antibody to hepatitis B core antigen (anti-HBc), hepatitis B surface antigen (HBsAg), antibody to HCV (anti-HCV), and antibody to HTLV-I (anti-HTLV-I). RESULTS: Anti-HAV was detected in 454 (99.1%), HBsAg in 5 (1.1%), anti-HBc in 33 (7.2%) and anti-HCV in 8 (1.7%) of serum samples tested in 1996. Statistically significant differences by gender or age group were nil. The prevalence of HCV infection was significantly higher in 1996 than in 1987 after adjusting for age of subjects living in the two villages (p < 0.01). The prevalence of HBsAg was significantly higher in 1996 than 1987 in Bhadrakali after adjusting for the factor of age (p < 0.05). Between 1987 and 1996, evidence for HTLV-1 positive residents was nil. CONCLUSION: These results suggest that HAV has been endemic in Nepal for long time while not of HBV, and that HCV infection tends to be increased recently.     

Nosocomial transmission of hepatitis B virus infection through multiple-dose vials.

The source of acute hepatitis B virus (HBV) infection in two women (55 and 72 years old) was investigated. They displayed no risk factors for acquiring HBV infection, other than treatment with local anaesthetic injections some months previously. The HBV strains were sequenced and showed distinct homology to strains seen in Swedish intravenous drug users (IVDU). Prior to these patients' acute infection, an outbreak of HBV had occurred among IVDU in the same county. Analysis of the HBV strains from six of these IVDUs showed their core promoter, precore and pre-S sequences (679 nucleotides) to be identical to those from the two patients. Cross-contamination between samples was excluded and the most likely source of infection was thought to be multiple-dose vials of local anaesthetic that had been contaminated with the HBV strain circulating among the IVDU population in the community. We believe that multiple-dose vials have no place in modern healthcare and recommend sequence homology analysis as an alternative or additional way to trace a source of HBV infection.     

Associations of pesticides, HCV, HBV, and hepatocellular carcinoma in Egypt

The rate of hepatocellular carcinoma (HCC) is increasing in Egypt where the major risk factors are chronic infections with hepatitis B and C viruses (HBV and HCV). A major segment of the population is employed in agriculture, raising the possibility that exposure to pesticides is an additional risk factor for HCC. The objective of this study is to investigate pesticides as environmental risk factors for HCC while taking into account viral risk factors. We conducted a case-control study of 236 subjects with confirmed HCC recruited from the National Cancer Institute, Cairo University, Egypt, and 236 controls matched on sex, age group and urban-rural status recruited from orthopedic department, Cairo University Hospital, Egypt. Patients who agreed to participate signed a consent form, answered a questionnaire and gave a blood sample for hepatitis virus testing. The manuals of the Ministry of Agriculture for approved use and type of pesticides since 1965 were linked to the questionnaire data for types of crops and pests that the subject had to combat, to attribute specific pesticides that were used by each subject. Subjects also reported duration of the exposure (years). Case-control comparisons in these data were stratified by sex, age group, and urban vs. rural residence. Data were analyzed using unconditional logistic regression models adjusting for age, HCV RNA, and current hepatitis B infection. Among rural males, the adjusted odds ratio (OR) for organophosphorus compounds was 2.7 (95% CI = 1.3-5.3) and for carbamates it was 2.9 (95% CI = 1.4-5.8). No statistically significant associations between HCC and pesticides were observed for urban males or for females. As expected, the strongest risk factors for HCC in this study were HCV RNA (OR = 16-17) and current HBV infection (OR = 27-28). This study therefore suggests that exposures to organophophorus and carbamate pesticides are additive risk factors to current HCV and HBV infection among rural males. Future investigation should address the possible hepatocarcinogenicity of pesticides using biomarkers of exposure and other techniques to better estimate dose-response relationships.