Epidemiology of viral hepatitis and hepatocellular carcinoma

Abstract

Most cases of hepatocellular carcinoma (HCC) are associated with cirrhosis related to chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Changes in the time trends of HCC and most variations in its age-, sex-, and race-specific rates among different regions are likely to be related to differences in hepatitis viruses that are most prevalent in a population, the timing of their spread, and the ages of the individuals the viruses infect. Environmental, host genetic, and viral factors can affect the risk of HCC in individuals with HBV or HCV infection. This review summarizes the risk factors for HCC among HBV- or HCV-infected individuals, based on findings from epidemiologic studies and meta-analyses, as well as determinants of patient outcome and the HCC disease burden, globally and in the United States.

Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Age-standardized incidence rates of liver cancer per 100,000 person-years, shown for different regions of the world and for men and women (GLOBOCAN 2002)

Figure 2

Prevalence of HBsAg carrier and chronic HCV status in different geographic regions (Custer et al., 2004) Melanesia (includes the Amphlett Islands, Bismarck Archipelago, d'Entrecasteaux Islands, Fiji, Louisiade Archipelago, Maluku Islands, New Caledonia, New Guinea, Norfolk Island, Raja Ampat Islands, RotumaSchouten Islands, Santa Cruz Islands, and Solomon Islands) Micronesia (Banaba, Gilbert Islands, Mariana Islands, Marshall Islands, Caroline Islands, Nauru, and Wake Island)

Figure 3

An association between baseline serum level of HBV DNA and future incidence of HCC. The cumulative incidence of HCC was also calculated for a subcohort of 2925 Taiwanese participants in the study REVEAL-HBV who were HBeAg-negative, had normal levels of ALT, and did not have cirrhosis when the study began. (modified from Chen CJ et al. JAMA. 2006;295:65–73)

Figure 4

Odds ratios for hepatocellular carcinoma, according to alcohol intake and the presence of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. The plot was obtained by fitting spline regression models on data obtained in Brescia, Italy, 1995–2000. (modified from Donato F et al. Am. J. Epidemiol. 2002;155:323-331)

Figure 5

Secular trends in the prevalence of cirrhosis, decompensated cirrhosis (left axis), and HCC (right axis) between 1996 and 2006 among HCV-infected veterans. The annual prevalence rates of these conditions were calculated by dividing the number of HCV patients with either a new or prior diagnosis by the total number of HCV patients with > 1 visit to a veteran’s administration hospital during that particular year. Modified from Kanwal F et al Gastroenterology 2011