Epidemiology of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Related Hepatocellular Carcinoma

Abstract

Introduction:Hepatocellular carcinoma (HCC) is one of the most prevalent primary malignant tumors and accounts for about 90% of all primary liver cancers. Its distribution varies greatly according to geographic location and it is more common in middle and low- income countries than in developed ones especially in Eastern Asia and Sub Saharan Africa (70% of all new HCCs worldwide), with incidence rates of over 20 per 100,000 individuals.Explanation:The most important risk factors for HCC are Hepatitis B Virus (HBV) infection, Hepatitis C Virus (HCV) infection, excessive consumption of alcohol and exposition to aflatoxin B1. Its geographic variability and heterogeneity have been widely associated with the different distribution of HBV and HCV infections worldwide.Chronic HBV infection is one of the leading risk factors for HCC globally accounting for at least 50% cases of primary liver tumors worldwide. Generally, while HBV is the main causative agent in the high incidence HCC areas, HCV is the major etiological factor in low incidence HCC areas, like Western Europe and North America.Conclusion:HBV-induced HCC is a complex, stepwise process that includes integration of HBV DNA into host DNA at multiple or single sites. On the contrary, the cancerogenesis mechanism of HCV is not completely known and it still remains controversial as to whether HCV itself plays a direct role in the development of tumorigenic progression.

Prevalence of Hepatitis C virus genotypes in nine selected European countries: A systematic review

“…Although this region displays a great heterogeneity especially considering the different historical context and the so variable social status, especially between Southern European countries (Italy, France, Spain, and Greece) and those included in the Balkan area (Albania, Bosnia, Montenegro, and Slovenia), the knowledge of the epidemiological characteristics of HCV infection can give a rational background for better understand not only the recent evolution of the infection in an area so close to Northern Africa and Middle Eastern and consequently strictly related to the migratory fluxes toward Europe but especially for the evaluation of the efficacy of the antiviral therapy, duration of treatment, and future burden of HCV infection . As widely described, indeed, knowledge of HCV genotypes distribution is an important tool for monitoring the efficacy of therapies whose primary purpose is to eradicate HCV RNA, which is predicted by the achievement of a SVR that seems to be associated with improved clinical outcomes .…”

“…Hepatitis C virus (HCV) with about 3‐4 million people infected every year and over 350 000 deaths is one of the main leading cause of liver‐related death worldwide . It has been estimated that over 71 million people have chronic hepatitis C infection mainly among populations of WHO Eastern Mediterranean and European Regions .…”

Epidemiology and viral risk factors for hepatocellular carcinoma in the Eastern Mediterranean countries

“…China has the highest incidence of HCC in the world, accounting for more than 40% of all HCC cases and 55% of liver cancer deaths [3,4] . Southern European countries have an intermediateincidence (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) cases per 100,000 population/year); while North America, South America, Northern Europe, and parts of Middle East have low-incidence rates (< 5 cases per 100,000 population/year) [3][4][5] . The incidence in Asian countries tends to decline in the past 2 decades whilst it increased in United States and Canada because of high rate of chronic hepatitis C virus (HCV)-related cirrhosis, nonalcoholic fatty liver disease and immigrants from HBV endemic regions [4] .…”

“…Owing to the high hepatitis B surface antigen (HBsAg) seroprevalance rates, HCC incidence is highest in East Asia and Africa. On the other hand, HCV is the etiological factor in approximately 20% of all HCC cases, particularly in the low-incidence regions such as Western Europe and North America [3,6] .…”

“…Furthermore, HCC is the third leading cause of cancer-related death [1][2][3] . Because of the low resectability rate, high recurrence rate after resection and poor response to the conservative treatment, the prognosis of HCC is poor with a 5-year survival rate of 6.9%…”