A prominent role of Hepatitis D Virus in liver cancers documented in Central Africa.
Hepatocellular Carcinoma (HCC) is one of the commonest cancers in Central Africa, a region with the unusual peculiarity to be hyperendemic for infections with Hepatitis B, C and D viruses. However, data estimating the respective proportions of HCC cases attributable to these viruses are still limited in this area. The current study was undertaken to determine the role of these viruses in HCC compared to non-HCC Cameroonian patients.



A case-control study was conducted in the Gastroenterology Unit of Central Hospital of Yaounde in collaboration with Centre Pasteur of Cameroon. Blood samples of all HCC cases (n = 88) and matched control individuals without known liver disease (n = 85) were tested for serological markers of Hepatitis B, C and D viral infections using commercially available enzyme immune-assay kits. Hepatitis B and C viral loads were quantified for positive patients by real-time PCR using commercial kits.



The mean age was 46.0 ± 18 and 42.1 ± 16 years old for HCC-patients and controls, respectively for a 2.3 Male/Female sex ratio. The prevalence of hepatitis B surface antigen, antibody to HCV and antibody to HDV were significantly higher in HCC patients (65.90, 20.26 and 26 % respectively) than in control patients (9.23, 4.62 and 1 %) (P < 2.5 10-5). The risk factors analysis showed that both HBV and HCV infections were strongly associated with HCC development in Cameroon with crude odds ratios of 15.98 (95 % CI 6.19-41.25) and 7.33 (95 % CI 2.09-25.77), respectively. Furthermore, the risk of developing HCC increased even more significantly in case of HBV and HDV co-infections with the odd ratio of 29.3 (95 % CI, 4.1-1231). HBV-DNA level was significantly higher in HBsAg-positive HCC-patients than in HBsAg-positive controls with (6.3 Log IU/mL and 5.7 Log IU/mL) respectively (P < 0.05).



HBV and HCV infections are the mains factors of HCC development in Cameroon. Our results show that patients co-infected with HDV are at very high risk to develop HCC. An active surveillance program of patients and, foremost, an easier access to antivirals and primary prevention measures are crucial steps to reduce the incidence of HCC in this country. Due to the lack of truly efficient antiviral therapy, the fate of HDV-infected patients remains, however, particularly worrying.
Virology Unit, Centre Pasteur of Cameroon, BP 1274, Yaounde, Cameroon.
Marie Atsama
MA
Amougou
Central Hospital of Yaounde, Yaounde, Cameroon.
Dominique Noah
DN
Noah
Laboratory of Pharmacology and Toxicology of University of Yaounde I, Yaounde, Cameroon.
Paul Fewou
PF
Moundipa
Unité « Organisation nucléaire et Oncogenèse », INSERM U993, Institut Pasteur, Paris, France.
Pascal
P
Pineau
Virology Unit, Centre Pasteur of Cameroon, BP 1274, Yaounde, Cameroon. njouom@pasteur-yaounde.org.
Richard
R
Njouom
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002163:Cameroon / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D019701:Hepatitis D, Chronic / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D003698:Hepatitis Delta Virus / Q000276:immunology; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D055815:Young Adult
Cameroon; Hepatitis B virus; Hepatitis C virus; Hepatitis D virus; Hepatocellular carcinoma