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Etiology of hepatocellular carcinoma in West Africa, a case-control study
Antoine Jaquet1,2, Boris Tchounga1,2,3, Aristophane Tanon4
1Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France.
Insights
Hepatocellular carcinoma (HCC) risk in West Africa is linked to Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections, and hazardous alcohol use. A synergistic effect between HBV and alcohol significantly increases HCC risk, highlighting the need for targeted prevention.
Area of Science:
- Hepatology
- Oncology
- Infectious Diseases
Background:
- Hepatocellular carcinoma (HCC) is a major health concern in West Africa, where Hepatitis B virus (HBV) infection is endemic.
- Limited data exists on other HCC risk factors, including alcohol consumption, Hepatitis C virus (HCV), and Human Immunodeficiency Virus (HIV) in this region.
Purpose of the Study:
- To investigate the independent and combined effects of alcohol use, HBV, HCV, and HIV infections on HCC risk in West Africa.
- To identify key modifiable risk factors for HCC in a high-prevalence HBV area.
Main Methods:
- A case-control study involving 160 HCC cases and 320 controls was conducted across referral hospitals in Abidjan, Bamako, and Lome.
- HCC diagnosis was based on ultrasound and α-fetoprotein levels. Serological tests for HIV, HBV, and HCV were performed, and hazardous alcohol use was assessed using the AUDIT questionnaire.
- Conditional logistic regression was employed to calculate odds ratios (OR) and 95% confidence intervals (CI).
Main Results:
- Hazardous alcohol use (OR=4.5), HBV infection (OR=62.5), and HCV infection (OR=35.9) were independently associated with HCC.
- A significant synergistic effect was observed between HBV infection and hazardous alcohol use (OR=149.8 for combined exposure).
- HBV mono-infection also showed a strong independent association with HCC (OR=57.4).
Conclusions:
- Alcohol use, HBV, and HCV infections are significant independent risk factors for HCC in West Africa.
- The combined effect of HBV infection and hazardous alcohol consumption poses a substantially elevated risk for HCC.
- Targeted screening and management of HBV infection and hazardous drinking are crucial for HCC prevention in West Africa.
Abstract:
Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case-control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space-occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α-fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38-57). Hazardous alcohol use (OR = 4.5 [CI 1.1-18.5]), HBV infection (OR = 62.5 [CI 20.5-190.7]) and HCV infection OR = 35.9 [CI 10.0-130.3]) were independently associated with HCC. Combining the effect of HBV infection and alcohol, HBV-infected hazardous drinkers had an OR = 149.8 (CI 13.5-1 667.0), HBV mono-infected had an OR = 57.4 (CI 18.8-175.3) (ref: HBV-negative). Aside the independent association of alcohol use and HBV and HCV infection with HCC, a synergic effect between alcohol use and HBV infection was identified. Timely screening and care of HBV infection and hazardous drinking might prevent a significant number of HCC in West Africa.
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