25Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. The prolyl hydroxylase 26 domain (PHD)-hypoxia inducible factor (HIF) pathway is a key mammalian oxygen sensing pathway and is frequently 27 perturbed by pathological states including infection and inflammation. We discovered a significant upregulation of 28 hypoxia regulated gene transcripts in patients with chronic hepatitis B (CHB) in the absence of liver cirrhosis. We used 29 state-of-the-art in vitro and in vivo HBV infection models to evaluate a role for HBV infection and the viral regulatory 30 protein HBx to drive HIF-signalling. HBx had no significant impact on HIF expression or associated transcriptional 31 activity under normoxic or hypoxic conditions. Furthermore, we found no evidence of hypoxia gene expression in HBV 32 de novo infection, HBV infected human liver chimeric mice or transgenic mice with integrated HBV genome. 33 Collectively, our data show clear evidence of hypoxia gene induction in CHB that is not recapitulated in existing models 34 for acute HBV infection, suggesting a role for inflammatory mediators in promoting hypoxia gene expression. 35 36 12 13 Although liver cirrhosis is a major risk factor for developing HCC, however, 10-20% of HBV infected patients that 14 develop HCC are non-cirrhotic, highlighting a role for HBV to promote carcinogenesis via direct and indirect 15 inflammatory mechanisms 7 . Three major and non-exclusive viral-dependent pathways have been proposed: (i) 16 integration of viral DNA into the host genome; (ii) expression of viral oncogenic proteins and (iii) viral-driven changes 17 in host gene transcription (reviewed in 8 ). The viral encoded regulatory hepatitis B X protein (HBx) has been reported 18to promote the expression of both viral and selected host genes, where a recent study reported HBx binding to >5,000 19 host genes with diverse roles in metabolism, chromatin maintenance and carcinogenesis 9 . There is clearly an urgent 20 need to increase our understanding of HBV mediated carcinogenesis to support the development of tools to identify 21 CHB patients at risk of HCC development. confirming increased expression of hypoxic genes in CHB liver (Fig.1b). To evaluate other enriched pathways in CHB 1 liver, GSEA was carried out using the Hallmark gene sets from MSigDB. This data base is curated to have minimal 2 overlap between categories, reducing noise and redundancy and summarize specific cell states or biological 3 processes. This analysis identified genes associated with allograft rejection as the most significantly upregulated gene 4 set in CHB. Interestingly HIF-1α was one of the leading-edge genes in this subset; contributing significantly to the core 5 enrichment score. Moreover, we noted a significant increase in inflammatory signaling pathways in CHB liver: 'TNFA 6 signaling via NF-kB', 'Inflammatory Response' and 'Interferon Gamma Response' (Fig.1c). In summary, these data 7 show increased hypoxic gene signatures in CHB liver that associates ...