Title: Effect of the HIV epidemic on liver cancer in Africa
Authors: Lessells RJ, Cooke GS.
Journal: Lancet,371:1504 (2008)


The timely Comment by Pierre Hainaut and Peter Boyle (Feb 2, p 367)1 makes surprisingly little mention of the potential eff ect of the HIV epidemic on the future burden of liver cancer in Africa, particularly the leading cause in sub-Saharan Africa, chronic hepatitis B virus (HBV) infection.

With the HIV epidemic still rampant, such cancer is likely to become more common. Just one reason for this is that HIV/HBV co-infected individuals exhibit higher HBV DNA levels and higher rates of HBeAg carriage than those who are HIV negative; both variables are predictors of hepatocellular carcinoma risk.

Vaccination is the cornerstone of plans for global control of HBV, yet HIV infection also threatens to diminish the eff ect of vaccination programmes: blunted response to hepatitis B vaccine is evident among HIV-infected children3 and adults, and vaccine-escape viral mutants have been detected among people receiving long-term antiviral therapy. Widespread transmission of vaccine-escape mutants could threaten the eff ectiveness of vaccination.

Beyond vaccination, the inclusion of HBV suppressive agents in anti retroviral rollout programmes (lami vudine, emtri citabine, and tenofovir) has the potential to have a positive eff ect on the incidence of HBV-related liver cancer.

However, with only lamivudine widely available in Africa, it is possible that as rollout of antiretroviral therapy reduces AIDS deaths, chronic liver disease including hepatocellular carcinoma will become increasingly common, as has been seen in cohorts from developed nations. Greater understanding of HBV/HIV interactions in Africa should be a high priority.

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Citation: Lessells RJ, Cooke GS. Effect of the HIV epidemic on liver cancer in Africa Lancet,371:1504 (2008).