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Hepatitis B virus genotype and mutants: risk factors for hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death behind only lung and colon cancers (1) and the principal cause of death among cirrhotic patients (2). The incidence of HCC is increasing in the United States and Europe (3). Hepatitis B virus (HBV) infection affects 400 million people worldwide and is the main risk factor for HCC in Eastern Asia and Africa (4,5). Aflatoxin B exposure further enhances the risk of tumor development in HBV-infected patients. In Western countries and in Japan, hepatitis C virus (HCV) infection, which affects approximately 170 million people worldwide, is the most prevalent risk factor for HCC (4,5). Cirrhosis is the main risk factor for HCC development and is the underlying cause of HCC in 80% of cases (4). The annual incidence of HCC is 0.4%–0.6% in HBV-infected noncirrhotic patients, 2% in HBV-infected cirrhotic patients, and 3%–8% in HCV-infected cirrhotic patients (4,5). Overall, one-third of cirrhotic patients will develop HCC during their lifetime.