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World J Hepatol. Feb 27, 2010; 2(2): 65-73
Published online Feb 27, 2010. doi: 10.4254/wjh.v2.i2.65
Hepatocellular carcinoma in African Blacks: Recent progress in etiology and pathogenesis
Michael C Kew
Michael C Kew, Department of Medicine, Groote Schuur Hospital, Old Main Building, K Floor, Main Road, Observatory 7935, Cape Town, South Africa
Author contributions: Kew CM contributed solely to this paper.
Correspondence to: Michael C Kew, Professor, MD, PhD, Department of Medicine, Groote Schuur Hospital, Old Main Building, K Floor, Main Road, Observatory 7935, Cape Town, South Africa.
Telephone: +27-21-4042126 Fax: +27-21-4486815
Received: June 4, 2009
Revised: January 14, 2010
Accepted: January 21, 2010
Published online: February 27, 2010

Occult hepatitis B virus (HBV) infection was shown to be present in 75% of Black Africans with hepatocellular carcinoma (HCC) in whom the tumor was hitherto not thought to be caused by chronic HBV infection. The association between chronic HBV infection and the development of the tumor is thus even closer than was originally thought. HBV viral load was found to be significantly higher in patients with HCC than in Black African controls. As in other populations, HBV e antigen-positive patients with hepatocellular carcinoma had significantly higher viral loads than patients negative for this antigen. The significance of this finding is discussed. The risk for HCC development with genotype A of HBV, the predominant genotype in African isolates, has not been investigated. Genotype A was shown to be 4.5 times more likely than other genotypes to cause HCC in Black Africans, and tumours occurred at a significantly younger age. Increasing numbers of patients with human immunodeficiency virus (HIV) and HBV co-infection are being reported to develop HCC. A preliminary case/control comparison supports the belief that HIV co-infection enhances the hepatocarcinogenic potential of HBV. A study from The Gambia provides the first evidence that dietary exposure to aflatoxin B1 may cause cirrhosis and that this may play a contributory role in the pathogenesis of aflatoxin-induced HCC. An animal model has provided experimental support for the clinical evidence that dietary iron overload in the African is directly hepatocarcinogenic, in addition to causing the tumor indirectly through the development of cirrhosis.

Keywords: Hepatocellular carcinoma, Black Africans, Occult hepatitis B, Virus infection, Hepatitis B viral loads, Hepatitis B virus genotype A, Aflatoxin, Dietary iron overload