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Hepatocellular Carcinoma in Sub-Saharan Africa
V V Pavan Kedar Mukthinuthalapati1,2, Vikash Sewram3, Ntokozo Ndlovu4
1Memorial Sloan Kettering Cancer Center, New York, NY.
Insights
Hepatocellular carcinoma (HCC) is highly prevalent in sub-Saharan Africa, primarily due to hepatitis B virus (HBV) infection. Improving prevention and treatment access is crucial to reduce HCC incidence and improve patient survival in the region.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) disproportionately affects sub-Saharan Africa (SSA), with over 80% of global cases occurring in SSA and Eastern Asia.
- Chronic hepatitis B virus (HBV) infection is the primary driver of HCC in SSA, particularly in West Africa, due to factors like incomplete vaccination and limited antiviral access.
Purpose of the Study:
- To highlight the significant burden of HCC in SSA.
- To identify key risk factors and challenges contributing to poor outcomes.
- To emphasize the need for improved strategies to combat HCC in the region.
Main Methods:
- Review of epidemiological data on HCC incidence and risk factors in SSA.
- Analysis of factors contributing to HBV endemicity and HCC development.
- Examination of survival rates and barriers to care for HCC patients in SSA.
Main Results:
- HBV infection is the leading cause of HCC in SSA, exacerbated by poor immunization and treatment access.
- Aflatoxins and African iron overload are additional risk factors.
- HIV/HBV co-infection increases HCC risk, and patients in SSA face the lowest survival rates due to late diagnosis and limited resources.
Conclusions:
- Multifaceted strategies are urgently needed to decrease HCC incidence in SSA.
- Improving surveillance, access to care, and antiviral therapies are critical for better patient outcomes.
- Addressing HBV, aflatoxins, and co-infections is essential for controlling HCC in sub-Saharan Africa.
Abstract:
More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.
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