Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa:a focus on surveillance

Human immunodeficiency virus(HIV)and hepatitis-B virus(HBV)infections are weighty public health challenges,especially in the African continent.The direct carcinogenic effect of HBV means that it remains a potent cause of early-onset hepatocellular carcinoma(HCC)in Sub-Saharan Africa(SSA),where it causes significant morbidity and mortality.The presence of HIV infection in HBV-infected patients poses a complicating factor,as coinfection has been shown to hasten the progression of liver disease to cirrhosis and HCC,and often resulting in early-age hepatocarcinogenesis with consequent late diagnosis and lower survival.In this review,we discuss this unique conundrum,the epidemiology of HIV-HBV coinfection in SSA,its effect on liver disease and development of HCC,as well as practices and barriers to HCC surveillance in this distinct population.We propose a way forward to curb this considerable health burden focusing on reduction of disease stigma,the need for easy-to-measure biomarkers,and implementation of large prospective studies in this population.