Association Between Viral Hepatitis Infection and Parkinson's Disease

A Population-based Prospective Study

Hwa-Young Choi; Thi Ha Mai; Kyung-Ah Kim; Hyunsoon Cho; Moran Ki


J Viral Hepat. 2020;27(11):1171-1178. 

In This Article

Abstract and Introduction


The association between hepatitis virus infection and Parkinson's disease remains controversial. To determine whether hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are associated with an increased risk of Parkinson's disease in Korean aged ≥40 years, we completed a population-based prospective study including patients without infections and those with HBV, HCV and HBV/HCV infections from 2005 to 2015. We used the International Classification of Diseases 10th Revision to identify Parkinson's disease (G20) and chronic hepatitis C virus (B18.2) and chronic hepatitis B virus infections (B18.0 or B18.1). To identify Parkinson's disease risk, competing risk analysis adjusted for age, sex, comorbidities and death was performed. Overall, 1 010 317 patients (358 052, noninfection; 488 990, hepatitis B; 144 459 hepatitis C; and 18 680 hepatitis B/C) were included. The incidence density of Parkinson's disease per 10 000 person-years was highest in the hepatitis C group (8.0), followed by the hepatitis B/C (6.8) and hepatitis B (5.0) groups. Hypertension, ischaemic heart disease, epilepsy, stroke and depressive disorder increased the hazard of Parkinson's disease in all groups. The adjusted hazard ratios were 1.25 (95% confidence interval: 1.17–1.35), 1.39 (95% confidence interval: 1.27–1.52) and 1.46 (95% confidence interval: 1.14–1.85) in the HBV, HCV, and HBV/HCV groups, respectively. Our findings suggest that adult patient of 40 years and older with HBV and HCV infections should be monitored for signs of Parkinson's disease so that early intervention and accurate treatment can be provided for minimizing the development and consequences of Parkinson's disease.


Parkinson's disease (PD) is the most common movement disorder and the second most common degenerative disease of the central nervous system, diagnosed in more than 10 million people worldwide.[1,2] The risk factors for PD are multifactorial that include genetic and environmental factors, such as advanced age, male sex or toxins.[2] In men, the risk of PD was found to be 1.5 times higher than that in women.[3] Interestingly, the number of men and women developing PD increases proportionally with age, suggesting that PD aetiology changes with age.[4]

Currently, some studies on the associations among hepatitis B virus (HBV) infection, hepatitis C virus (HCV) infection and PD have shown HCV infection to be consistently associated with an increased risk of PD. At least 1 year post-HCV infection, the rate ratio for PD was 1.43 in England, the odds ratio (OR) for PD was 1.39 in Taiwan, and the hazard ratio (HR) of PD was 1.29 in Taiwan.[5–7] However, the association between HBV infection and PD remains controversial. A recent study by Pakpoor et al[5] illustrated that HBV infection caused a 1.82-fold increase in PD risk compared to that in a reference cohort, whereas the association between HBV infection and PD was not found to be statistically significant in other studies.[6,8]

In 2015, of the 257 million people with chronic HBV infection and 71 million people with chronic HCV infection worldwide, 887 000 and 399 000 people died (mostly from complications including cirrhosis and hepatocellular carcinoma), respectively.[8] The increase in the ageing population in South Korea suggests a high risk of PD in the future as advancing age is one of the most important risk factors of PD. In 2016, the percentage of seniors aged ≥65 years in South Korea reached 13% (approximately 7 million) of the whole population and is predicted to increase to >40.1% in 2060 (Statistics Korea). According to our survey of the literature, no population-based prospective study has been conducted to demonstrate the relationships among HBV, HCV and PD; therefore, we believe that the current study might be the first population-based study of its kind.

We hypothesized that HBV and HCV infections are associated with an increased risk of PD. This study was designed to test this hypothesis by addressing two specific aims: (a) to determine the incidence of PD among participants with HBV or HCV infections; (b) to determine the associations of HBV and HCV infections with PD. Pursuing these aims will help in better understanding of the epidemiology of PD among the Korean population as well as in evaluating the effects of HBV and HCV infections on the development of PD.