How undiagnosed Hepatitis B is driving liver cancer rates in Africa
In Africa, where roughly 64 million people live with chronic hepatitis B, the infection remains the leading cause of liver cancer.
What you need to know:
- With Africa accounting for nearly 68 percent of new global infections, Hepatitis B remains a hidden danger that can damage the liver for decades without symptoms.
You may feel perfectly healthy and still be living with hepatitis B without knowing it. The virus can quietly damage your liver for years, with symptoms sometimes appearing only after serious complications have developed. Although hepatitis B is preventable, it remains a leading cause of liver cancer and premature death worldwide. Much of this suffering can be avoided through vaccination, a simple blood test, and effective treatment.
Hepatitis B is caused by the hepatitis B virus (HBV), one of five main viruses that cause hepatitis: A, B, C, D, and E. While some types cause only short-term illness, HBV can persist in the body for life. Over time, the chronic inflammation it triggers can scar the liver, potentially leading to cirrhosis, liver failure, and hepatocellular carcinoma (HCC), the most common type of primary liver cancer.
The impact of hepatitis B is severe in Africa. According to the World Health Organization (WHO), around 240 million people globally were living with chronic hepatitis B in 2024, with roughly 64 million of them in Africa. That year, Africa accounted for nearly 68 percent of the estimated 900,000 new infections worldwide. Hepatitis B also caused about 1.1 million deaths, mostly from cirrhosis and liver cancer.
Not everyone with chronic hepatitis B will develop cancer, but the link between HBV and liver cancer is among the strongest infection-cancer connections. The International Agency for Research on Cancer reported that hepatitis B caused about 380,000 cancer cases globally in 2020.
In sub-Saharan Africa, hepatitis B remains the leading cause of hepatocellular carcinoma. Exact figures vary by country, but studies indicate that HBV is responsible for about half of liver cancer cases in the region. In high-prevalence areas, particularly in West Africa, it is linked to 70 to 80 percent of liver cancers in younger adults.
This is why liver cancer in Africa often strikes at a younger age than in other parts of the world.
The virus spreads through infected blood and certain body fluids. In regions where it is common, transmission most often occurs from an infected mother to her baby during birth or through close contact in early childhood. It can also spread via unprotected sex, needle or syringe sharing, unsafe medical injections, contaminated tattoo or piercing equipment, occupational exposure to infected blood, or sharing sharp personal items like razors.
However, hepatitis B does not spread through everyday contact. You cannot catch it by sharing food or water, using the same utensils, breastfeeding, hugging, holding hands, coughing, or sneezing. People living with hepatitis B should not face stigma or discrimination.
One of the biggest challenges of hepatitis B is its silence. It often produces no symptoms for many years. Like HIV, a person can look and feel perfectly healthy while the virus quietly harms their liver.
When symptoms do appear, they may include yellowing of the eyes or skin (jaundice), dark urine, severe fatigue, nausea, vomiting, abdominal pain, joint pain, and flu-like symptoms. In rare cases, an acute infection can cause sudden, serious liver failure.
Severe complications typically arise after decades of chronic infection. Advanced liver disease can cause a swollen abdomen due to fluid buildup (ascites), loss of appetite, weight loss, vomiting blood, confusion, malnutrition, kidney problems, cirrhosis, or liver failure.
Waiting for these symptoms is risky, because advanced liver disease is much harder to treat. The best way to prevent serious complications is to detect the infection early.
The only reliable way to know whether someone has hepatitis B is through a blood test. Symptoms alone cannot confirm the infection or distinguish it from other liver problems. Blood tests can show whether the infection is recent or chronic, whether a person has developed immunity after vaccination, or whether a previous infection has cleared. Additional tests can measure the amount of virus in the blood and assess the risk of disease progression and transmission.
Doctors can also use tools like ultrasound, FibroScan, and other imaging scans to check whether the liver has developed significant scarring.
Testing is especially important because many people do not know they are infected. In 2024, only about 65 million people, roughly 27 per cent of those with chronic hepatitis B worldwide, knew their status. Pregnant women should be tested, because identifying infection allows for interventions that can dramatically reduce transmission to newborns. Household contacts, sexual partners of infected individuals, healthcare workers, and people exposed to infected blood should also consider testing.
Also read: Prevention and treatment of Hepatitis B
Early treatment of hepatitis B can prevent liver cancer. Most people with uncomplicated acute hepatitis B do not require specific antiviral medicine, as many recover on their own. However, chronic hepatitis B can be managed effectively with oral antiviral drugs. This treatment reduces the risk of cirrhosis and lowers the likelihood of liver cancer. For many patients, treatment is long-term and may be lifelong.
It is important to remember that antiviral treatment does not replace regular check-ups. People with chronic hepatitis B still have a risk of liver cancer, especially if they have cirrhosis or other risk factors, so they need ongoing medical care.
Vaccination remains the best protection against hepatitis B. Every child should receive the first dose of the hepatitis B vaccine as soon as possible after birth, ideally within 24 hours, followed by the remaining doses according to the national immunization schedule.
Children, teenagers, and adults who have not been vaccinated should also complete the full recommended series. Babies born to mothers with hepatitis B need urgent protection, and mothers with high viral levels may require antiviral treatment during pregnancy to reduce the risk of transmission. Completing the full hepatitis B vaccine series provides more than 95 percent protection.
Being diagnosed with hepatitis B does not mean someone cannot live a normal, productive life. People with the infection can continue working, studying, and participating in family and community activities.
They should maintain regular medical check-ups, eat a healthy diet, exercise regularly, avoid alcohol, and consult a doctor before using any herbal or over-the-counter medicines, since some products can harm the liver. They may also need testing for other viral hepatitis types, such as hepatitis C, and may require the hepatitis A vaccine if
recommended.
Hepatitis B can quietly damage the liver, but liver cancer from HBV does not have to happen. Vaccination can stop the infection. Testing can find those at risk. Treatment can slow the disease and save lives.
The problem is not that we lack solutions. The real challenge is ensuring that people know their status and can access prevention and care. A simple vaccine, a blood test, and timely treatment can prevent lifelong liver disease.
Dr Opio is associate professor, Aga Khan University Medical College and consultant gastroenterologist & hepatologist at Aga Khan University Hospital
