Hepatitis B, C and D virus infections and risk of hepatocellular carcinoma in Africa: A meta-analysis including sensitivity analyses for studies comparable for confounders

• Published in: PloS one Vol. 17; no. 1; p. e0262903
• Main Authors: Donatien Serge Mbaga, Sebastien Kenmoe, Cyprien Kengne-Ndé, Jean Thierry Ebogo-Belobo, Gadji Mahamat, Joseph Rodrigue Foe-Essomba, Marie Amougou-Atsama, Serges Tchatchouang, Inès Nyebe, Alfloditte Flore Feudjio, Ginette Irma Kame-Ngasse, Jeannette Nina Magoudjou-Pekam, Lorraine K M Fokou, Dowbiss Meta-Djomsi, Martin Maïdadi-Foudi, Sabine Aimee Touangnou-Chamda, Audrey Gaelle Daha-Tchoffo, Abdel Aziz Selly-Ngaloumo, Rachel Audrey Nayang-Mundo, Jacqueline Félicité Yéngué, Jean Bosco Taya-Fokou, Raoul Kenfack-Momo, Efietngab Atembeh Noura, Cynthia Paola Demeni Emoh, Hervé Raoul Tazokong, Arnol Bowo-Ngandji, Carole Stéphanie Sake, Etienne Atenguena Okobalemba, Jacky Njiki Bikoi, Richard Njouom, Sara Honorine Riwom Essama
• Format: Journal Article
• Language: English
• Published: Public Library of Science (PLoS) 01-01-2022
• ISSN: 1932-6203
• DOI: 10.1371/journal.pone.0262903

IntroductionAfrica denotes unique facies for hepatocellular carcinoma (HCC) characterized by a conjunction of low sensitization, restricted access to diagnosis and treatment and associated with the highest incidence and mortality in the world. We investigated whether hepatitis B (HBV), C (HCV) and D (VHD) viruses were etiological agents of HCC in Africa.MethodsRelevant articles were searched in PubMed, Web of Science, African Index Medicus, and African Journal Online databases, as well as manual searches in relevant reviews and included articles. Analytical studies from Africa evaluating the association between HCC development and HBV, HCV, and HDV were included. Relevant studies were selected, data extracted, and the risk of bias assessed independently by at least 2 investigators. The association was estimated using odds ratios (OR) and their 95% confidence interval (95% CI) determined by a random-effects model. Sources of heterogeneity were determined by subgroup analyses.ResultsA total of 36 case-control studies were included. With controls having non-hepatic disease, the overall results suggested a significantly increased risk of HCC in patients with HBV (HBeAg (OR = 19.9; 95% CI = [3.7-105.2]), HBsAg (OR = 9.9; 95%) CI = [6.2-15.6]) and DNA (OR = 8.9; 95% CI = [5.9-13.4]); HCV (Anti-HCV (OR = 9.4; 95% CI = [6.3-14.0]) and RNA (OR = 16.5; 95% CI = [7.8-34.6]); HDV (Anti-VHD, (OR = 25.8; 95% CI = [5.9-112.2]); and HBV/HCV coinfections (HBV DNA/HCV RNA (OR = 22.5; 95% CI = [1.3-387.8]). With apparently healthy controls, the overall results suggested a significantly increased risk of HCC in patients with HBV (HBsAg, (OR = 8.9; 95% CI = [6.0-13.0]); HCV (Anti-HCV, (OR = 7.7; 95% CI = [5.6-10.6]); and HBV/HCV coinfections (HBsAg/Anti-HCV (OR = 7.8; 95% CI = [4.4-13.6]) Substantial heterogeneity and the absence of publication bias were recorded for these results.ConclusionsIn Africa, HBV/HCV coinfections and HBV, HCV, and HDV infections are associated with an increased risk of developing HCC. The implementation of large-scale longitudinal and prospective studies including healthy participants to search for early biomarkers of the risk of progression to HCC is urgently needed.