What are risk factors for hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) (Hep B)?

Updated: Jun 08, 2021
  • Author: Nikolaos T Pyrsopoulos, MD, PhD, MBA, FACP, AGAF; Chief Editor: BS Anand, MD  more...
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Significant risk factors for carcinogenesis include the following:

  • Older age

  • Exposure to aflatoxins

  • Alcohol

  • Coinfection with HCV and HDV

  • Immune status

  • Genotype

  • Core and precore mutations

  • Cirrhosis

  • Thrombocytopenia

High serum viral load (ie, viral replication) that is persistently elevated over time is the most reliable indicator in predicting the development of HCC. [36]

Even the presence of hepatitis B core antibody (anti-HBc) in the absence of hepatitis B surface antigen (HBsAg) or HBV DNA is significantly related to an increased risk for HCC, although there are no recommendations for HCC surveillance in such cases unless cirrhosis is present.

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