Aflatoxin B₁ exposure increases the risk of cirrhosis and hepatocellular carcinoma in chronic hepatitis B virus carriers

Abstract

The relation between aflatoxin B1 (AFB1) and cirrhosis in chronic carriers of hepatitis B virus (HBV) remains inconclusive. This case-control study nested in a large community-based cohort aimed to assess the effect of AFB1 exposure on cirrhosis and HCC in chronic HBV carriers. Serum AFB1-albumin adduct levels at study entry were measured in 232 cirrhosis cases, 262 HCC cases and 577 controls. Multivariate-adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were estimated using logistic regression. Among all chronic HBV carriers, the time intervals between study entry and diagnosis of HCC, cirrhosis, cirrhotic HCC, and non-cirrhotic HCC were all significantly (p<0.0001) shorter in participants with high serum levels of AFB1-albumin adducts than those with low/undetectable levels. There were significant dose-response relations with serum AFB1-albumin adduct level at study entry for cirrhosis (p-trend=0.0001) and cirrhotic HCC (p-trend<0.0001) newly-diagnosed within 9 years after entry as well as non-cirrhotic HCC (p-trend=0.021) newly-diagnosed within 4 years after entry. The aORs (95% CIs) for high vs. undetectable serum AFB1-albumin adduct levels were 2.45 (1.51–3.98) for cirrhosis (p=0.0003), 5.47 (2.20–13.63) for cirrhotic HCC (p=0.0003), and 5.39 (1.11–26.18) for non-cirrhotic (p=0.0368) HCC, respectively. There remained a significant dose-response relation between serum AFB1-albumin adduct level and HCC risk (p-trend=0.0291) in cirrhosis patients, showing an aOR (95% CI) of 3.04 (1.11–8.30) for high vs. undetectable serum levels (p=0.0299). It is concluded that AFB1 exposure may increase the risk of cirrhosis and HCC in a dose-response manner among chronic HBV carriers.

Expression of P62 in hepatocellular carcinoma involving hepatitis B virus infection and aflatoxin B1 exposure

“…It is reported that 5–28% of global HCC cases may be due to AFB1 exposure . Vandel studies have shown that chronic HBV infection is associated with AFB1 exposure in some countries with high HCC rates; infection and toxin consumption are two major causes of risk factors for liver cancer and further health problems in incident areas The Guangxi region in southwestern China has high prevalence of HBV . Because of the warm and humid climate, many crops, especially maize and peanut, are easily polluted by AFB1.…”

The Relationship of Aflatoxin B1 and Hepatocellular Carcinoma: A Mini Review

“…Although AFB1 has been casually associated with HCC [3], the long exposure periods to this toxin may induce the development of HCC [7], World Health Organization has stated that it's a highly potent carcinogenic toxin for the liver [6], therefore it's important to establish AFB1 as an epidemiological priority for health authorities in regions where HCC has a high incidence.…”

“…It is important to note that most cases of HCC occurs in the chronic liver disease or cirrhosis setting, thus cirrhosis is consider an emerging major global health problem [16]. One of the most recent community base case-control study in Taiwan determined that the exposure to AFB1 thru a period of 9 years may predict the development of HCC in chronic HBV carriers [7].…”

“…In recent years, research has demonstrated that aflatoxin exposure is also linked to the occurrence of a specific mutation in the p53 tumor suppressor gene as mechanism of disease pathogenesis in HCC [6]. The development of HCC is a multistage process with liver cell destruction, regeneration ending in fibrosis and cirrhosis, establishing a premalignant condition [7].…”

Hepatocellular Carcinoma: Known and Emerging Risk Factors

“…Co-factors such as family history of HCC, exposure to mycotoxins (aflatoxin), alcohol abuse or tobacco dependence, HCV and/or HDV co-infections, greatly increase the risk of HCC [11] [12].…”