Background: The pathogenesis of hepatocellular carcinoma (HCC) in alcoholics is not understood well. Occult hepatitis B virus (HBV) infection may have some roles.

Methods: We compared the clinical features of HCC in patients with and without a history of excessive alcohol consumption. For hepatitis B surface antigen (HBsAg)-negative, anti–hepatitis C virus (HCV)-negative (NBNC) patients, HBV DNA in the tumor was detected by polymerase chain reaction (PCR)-Southern blotting. Integrated and episomal forms of HBV DNA were detected using agarose gel electrophoresis after nested PCR and were quantified by real-time PCR.

Results: For patients who were anti–HCV positive in serum, the age at diagnosis of HCC was lower for alcoholics than nonalcoholics. For serum HBsAg-positive patients and those who were NBNC, the age at diagnosis of HCC was the same for alcoholics and nonalcoholics. The numbers of tumors and of patients with vascular invasion did not differ between alcoholics and nonalcoholics in any subset. In three NBNC-HCC patients with a history of alcohol abuse, HBV DNA was detected in the tumor. Integrated HBV DNA was detected in one patient, and the episomal form of HBV DNA was detected in two patients.

Conclusion: HBV may be found in episomal and integrated forms in the chromosomal DNA of the livers of habitual drinkers who are negative for HBsAg and anti-HCV and may have a direct role in hepatocarcinogenesis.