1. ¹Inserm, U812, Paris, France
2. ²Université Paris Descartes, Faculté de Médecine René Descartes, CHU Necker, Paris, France
3. ³Institut Pasteur, Paris, France
4. ⁴Inserm, U807, Paris, France
5. ⁵Inserm, U785, Villejuif, France
6. ⁶Université Paris-Sud 11, Faculté de Médecine, Villejuif, France

Correspondence: Dr C Brechot, INSERM U785, University Paris XI, Liver Hepatobiliary Centre, Paul Brousse Hospital, Villejuif 94800, France. E-mail: brechot@vjf.inserm.fr

Abstract

As discussed in detail in other chapters of this review, chronic hepatitis B (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC). Most HCCs complicate the evolution of an active or inactive cirrhosis. However, some tumors occur on livers with minimal histological changes; the prevalence of such cases varies from one geographical region to the other, being much higher in the southern half of Africa (around 40% of HCCs) than in Asia, America and Europe, where at least 90% of HCCs are associated with the cirrhosis. This heterogeneity is probably a reflection of different environmental and genetic factors. This review will summarize the current knowledge on the mechanisms involved in HBV-related liver carcinogenesis. It will show in particular how viruses can be viewed as tools to discover and dissect new cellular pathways involved in cancer development and emphasize the potential synergistic effects between HBV and hepatitis C virus, as well as between viral infections and other environmental factors, such as alcohol.