A 40-year-old man has a history of intravenous drug use. Physical examination shows needle tracks in his left antecubital fossa. He has mild scleral icterus. Serologic studies for HBsAg and anti-HCV are positive. He develops hepatocellular carcinoma 15 years later. Which of the following viral characteristics best explains why this patient developed hepatocellular carcinoma?
Although the hepatitis B virus (HBV) and hepatitis C virus (HCV) genomes do not encode for any transforming proteins, the regenerating hepatocytes are more likely to develop mutations, such as inactivation of p53. HBV does not have a consistent site of integration in the liver cell nuclei, and it does not contain viral oncogenes. Many DNA viruses, such as human papillomavirus (HPV), inactivate tumor suppressor genes, but there is no convincing evidence that HBV or HCV can bind to p53 or RB proteins. Also, the HBV-encoded regulatory element, called HBx, disrupts the normal growth of infected hepatocytes. Neither HBV nor HCV infects immune cells.
Viral integration in the vicinity of proto-oncogenes
Viral capture of proto-oncogenes from host cellular DNA
Viral inflammatory changes with genomic damage
Viral inactivation of RB and p53 gene expression
Neoplasia