Hepatocellular carcinoma risk in Sub-Saharan African and Afro-Surinamese individuals with chronic hepatitis B living in Europe

Cross-sectional studies have identified individuals from sub-Saharan Africa with (SSA) chronic hepatitis B (CHB) as a potential risk group for hepatocellular carcinoma (HCC). However, the incidence of HCC and performance of HCC risk scores in this population are unknown.We conducted an international multicenter retrospective cohort study of all consecutive hepatitis B virus (HBV) mono-infected individuals with SSA or Afro-Surinamese (AS) ethnicity managed at sites in the Netherlands, the United Kingdom and Spain. We assessed the 5 and 10 year cumulative incidence of HCC in the overall study population, among different clinically relevant subgroups and across (m)PAGE-B subgroups. Next, we explored the different risk factors for HCC.During a median follow-up of 8 years we analyzed 1473 individuals of whom, 34 developed HCC. The 5 and 10 year cumulative incidences of HCC were 1% and 2.4%. The 10 year cumulative incidence of HCC was 0.7% among individuals without advanced fibrosis at baseline, compared to 12.1% among individuals with advanced fibrosis (p<0.001). Higher age (adjusted hazard ratio [aHR] 1.05), lower platelet count (aHR 0.98), lower albumin level (aHR 0.90) and higher HBV DNA log10 (aHR 1.21) were significantly associated with HCC development. The 10 year cumulative incidence of HCC was 0.5% among individuals with a low PAGE-B score, compared to 2.9% in the intermediate and 15.9% in the high risk group (p<0.001).This unique international multicenter cohort of SSA and AS individuals with CHB showed a 5 and 10 year cumulative HCC risk of 1% and 2.4%. The risk of HCC was negligible for individuals without advanced fibrosis at baseline, and among individuals with low baseline (m)PAGE-B scores. These findings can be used to guide HCC surveillance strategies.Sub-Sahara African ethnicity has been associated with a higher risk of hepatocellular carcinoma among individuals with chronic hepatitis B. In this international multicenter cohort study of sub- Saharan African and Afro-Surinamese individuals living with chronic hepatitis B in Europe, we found a 5 and 10 year cumulative incidence of hepatocellular carcinoma of 1% and 2.4%. The risk was negligible among individuals without advanced fibrosis and a low baseline (m)PAGE-B score. These findings can be used to guide HCC surveillance strategies in this population.