Hepatitis B virus (HBV) infection is a leading risk factor for hepatocellular carcinoma (HCC). HBV integration into the host genome has been reported, but its scale, impact and contribution to HCC development is not clear. Here, we sequenced the tumor and nontumor genomes (>803 coverage) and transcriptomes of four HCC patients and identified 255 HBV integration sites. Increased sequencing to 2403 coverage revealed a proportionally higher number of integration sites. Clonal expansion of HBV-integrated hepatocytes was found specifically in tumor samples. We observe a diverse collection of genomic perturbations near viral integration sites, including direct gene disruption, viral promoterdriven human transcription, viral-human transcript fusion, and DNA copy number alteration. Thus, we report the most comprehensive characterization of HBV integration in hepatocellular carcinoma patients. Such widespread random viral integration will likely increase carcinogenic opportunities in HBV-infected individuals.[Supplemental material is available for this article.] . HBV integration into the host genome has been reported both in tumors (Gozuacik et al. 2001;Murakami et al. 2005;Saigo et al. 2008) and in nontumor liver tissue from HBV-infected individuals (Mason et al. 2010), although such integration is not essential for HBV replication. The relative extent, mutation model, and the functional impact of HBV integration in host genomes is not clear due to the lack of an unbiased approach to identify and quantify genome-wide HBV integration sites. Recent advances in sequencing technologies (Meyerson et al. 2010) provide an opportunity to investigate the global extent, mutation model, and functional impact of viral integration in the host genome. Recently, a primary hepatitis C virus-infected HCC patient has been subjected to whole-genome sequencing, and many somatic mutations were reported (Totoki et al. 2011). However, as an RNA virus, HCV never integrates into the host genome during its life cycle; therefore, liver cancer with HCV infection is not an optimal model to study viral-human genomic interactions. To that end, sequencing the genome and transcriptome of an HBV-positive HCC patient provides a great opportunity to reveal the functional impact of viral integration on the host genome.