Hepatitis B virus infection and hepatocellular carcinoma in sub-Saharan Africa: Implications for elimination of viral hepatitis by 2030?

Abstract

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

Figure 1

Projected increase in estimated number of cases and deaths due to cancers of the liver and intrahepatic bile ducts within sub-Saharan Africa from 2020 to 2040[67,76,77]. GLOBOCAN 2020 (https://gco.iarc.fr/). A: Estimated number of cases from 2020 to 2040, both sexes, age (0-85+); B: Estimated number of deaths from 2020 to 2040, both sexes, age (0-85+).

Figure 2

Estimated age-standardized liver cancer incidence and mortality rates per 100000 persons per year shown worldwide in 2020[2,67,78]. GLOBOCAN 2020 (https://gco.iarc.fr/). WHO: World Health Organization; ASR: Liver cancer age standardized incidence rate.

Figure 3

Estimated age-standardized liver cancer incidence rates per 100000 persons per year in males in Africa (2020)[2,67,78]. GLOBOCAN 2020 (https://gco.iarc.fr/). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization/International Agency for Research on Cancer concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted or dashed lines on maps represent approximate borderlines for which there may not yet be full agreement.

Figure 4

Estimated age-standardized liver cancer mortality rates per 100000 persons per year in males in Africa (2020)[2,67,78]. GLOBOCAN 2020 (https://gco.iarc.fr/). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization/International Agency for Research on Cancer concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted or dashed lines on maps represent approximate borderlines for which there may not yet be full agreement.