Hepatitis B virus and primary liver cancer in Hepatitis B surface antigen positive and negative patients

The review by Dr Johnson clearly indicates the strength of the epidemiological association between chronic infection by HBV and hepatocellular carcinoma (HCC), the most frequent histological form of primary liver cancer (PLC). However, the mechanisms involved in liver carcinogenesis still remain a matter of debate. Cirrhosis, which is present in around 90% of patients with HCC tumors in most areas, has long been recognized as an important risk factor. Early clinical observations in Africa showed the evolution of acute hepatitis (AH) to chronic active hepatitis (CAH), cirrhosis and, eventually, liver cancer [1, 2]. The importance of this association has since been confirmed but its prevalence is considered to be lower in Africa (around 50% of cases) than in Asia, Europe, and America (80–100%). The molecular basis of the promoting effect of cirrhosis is far from clear but generally related to “liver cell regeneration”.