Etiology of hepatocellular carcinoma in West Africa,a case–control study |
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| Authors: | Antoine Jaquet Boris Tchounga Aristophane Tanon Aklesso Bagny Didier K. Ekouevi Hamar A. Traore Annie J. Sasco Moussa Maiga François Dabis |
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| Affiliation: | 1. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France;2. Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France;3. Programme PACCI, CHU de Treichville, Abidjan, C?te d'Ivoire;4. Service de Maladies Infectieuses et Tropicales (SMIT), CHU de Treichville, Abidjan, C?te d'Ivoire;5. Service d'hépato‐gastroentérologie, CHU Campus, Lomé, Togo;6. Département de Santé Publique, Faculté des Sciences de la santé, Université de Lomé, Lomé, Togo;7. Service de médecine interne, CHU du Point G, Bamako, MALI;8. Service d'Hépato‐Gastroentérologie, H?pital Gabriel Touré, Bamako, Mali |
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| Abstract: | Hepatocellular carcinoma (HCC) is a leading cause of cancer in West Africa where HBV infection is endemic. However, limited information is available on other risk factors such as alcohol use, HCV and HIV infection. A case–control study was conducted in referral hospitals of Abidjan (Cote d'Ivoire), Bamako (Mali) and Lome (Togo). Cases were matched with controls on age, gender and participating site. The diagnosis of HCC relied on the combination of one or more space‐occupying lesions suggestive of an HCC on a standardized abdominal ultrasound and an α‐fetoprotein level ≥400 ng/ml. HIV, HBV and HCV serology were performed. Hazardous alcohol use was assessed using the AUDIT questionnaire. A conditional logistic regression model was used to measure odds ratio (OR) with their 95% confidence intervals (CI). A total of 160 cases and 320 controls were included. Cases were predominantly men (80.0%) with a median age of 47 years (IQR 38–57). Hazardous alcohol use (OR = 4.5 [CI 1.1–18.5]), HBV infection (OR = 62.5 [CI 20.5–190.7]) and HCV infection OR = 35.9 [CI 10.0–130.3]) were independently associated with HCC. Combining the effect of HBV infection and alcohol, HBV‐infected hazardous drinkers had an OR = 149.8 (CI 13.5–1 667.0), HBV mono‐infected had an OR = 57.4 (CI 18.8–175.3) (ref: HBV‐negative). Aside the independent association of alcohol use and HBV and HCV infection with HCC, a synergic effect between alcohol use and HBV infection was identified. Timely screening and care of HBV infection and hazardous drinking might prevent a significant number of HCC in West Africa. |
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| Keywords: | hepatocellular carcinoma HIV hepatitis B virus hepatitis C virus Africa |
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