Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2021; 27(36): 6025-6038
Published online Sep 28, 2021. doi: 10.3748/wjg.v27.i36.6025
Hepatitis B virus infection and hepatocellular carcinoma in sub-Saharan Africa: Implications for elimination of viral hepatitis by 2030?
Edina Amponsah-Dacosta
Edina Amponsah-Dacosta, Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, Western Cape, South Africa
Author contributions: Amponsah-Dacosta E defined the topic, performed the literature search, screened, and reviewed the literature, and wrote the manuscript.
Supported by The Harry Crossley Postdoctoral Research Fellowship 2021.
Conflict-of-interest statement: The author has no conflict of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Edina Amponsah-Dacosta, PhD, Postdoctoral Fellow, Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, Western Cape, South Africa.
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: May 1, 2021
Revised: May 10, 2021
Accepted: August 13, 2021
Article in press: August 13, 2021
Published online: September 28, 2021

Elimination of viral hepatitis in sub-Saharan Africa by 2030 is an ambitious feat. However, as stated by the World Health Organization, there are unprecedented opportunities to act and make significant contributions to the elimination target. With 60 million people chronically infected with hepatitis B virus (HBV) of whom 38800 are at risk of developing highly fatal hepatocellular carcinoma (HCC) every year, sub-Saharan Africa faces one of the greatest battles towards elimination of viral hepatitis. There is a need to examine progress in controlling the disproportionate burden of HBV-associated HCC in sub-Saharan Africa within the context of this elimination target. By scaling-up coverage of hepatitis B birth dose and early childhood vaccination, we can significantly reduce new cases of HCC by as much as 50% within the next three to five decades. Given the substantial reservoir of chronic HBV carriers however, projections show that HCC incidence and mortality rates in sub-Saharan Africa will double by 2040. This warrants urgent public health attention. The trends in the burden of HCC over the next two decades, will be determined to a large extent by progress in achieving early diagnosis and appropriate linkage to care for high-risk chronic HBV infected persons.

Keywords: Hepatitis B virus, Viral hepatitis, Hepatocellular Carcinoma, Elimination, Human Immunodeficiency Virus, Sub-Saharan Africa

Core Tip: Chronic hepatitis B virus (HBV) infection is the primary risk factor for hepatocellular carcinoma (HCC) in sub-Saharan Africa. In 2020, HBV-associated HCC accounted for approximately 36700 deaths. By 2040, it is projected that approximately 72200 people will die each year from this disease without an intensive public health response. The high mortality-to-incidence ratio associated with HCC in sub-Saharan Africa suggests significant inequities in access to appropriate health care. This review examines the evidence on the extent of the disease burden in sub-Saharan Africa and advocates for prioritizing HCC control as part of ongoing viral hepatitis elimination strategies within this region.