Hepatocellular Carcinoma in Viral Hepatitis in Pakistan: Epidemiology, Clinical Challenges, and Transformative Strategies for Control
DOI:
https://doi.org/10.63521/pjg.42.1.2026.78Keywords:
hepatocellular carcinoma, Hepatitis C, Sofosbuvir, HCV RNA PCR, SVR, Pakistan, DAAs, viral, hepatitis, pakistanAbstract
Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in Pakistan, driven by chronic viral hepatitis, particularly hepatitis C virus (HCV) and hepatitis B virus (HBV). This article examines the epidemiology, clinical challenges, and transformative strategies to address HCC in Pakistan, with a focus on viral hepatitis.
Methods: A systematic review was conducted using PubMed, PMC, PakMediNet, and Google Scholar, covering studies from January 2000 to July 2025. We included studies on HCC etiology, prevalence, clinical presentation, and outcomes in Pakistan. Random-effects meta-analyses estimated pooled prevalence of HCV and HBV in HCC patients. Data on risk factors, diagnostic delays, and treatment access were synthesized.
Results: HCV is implicated in 67.9%–70.1% of HCC cases, with HBV contributing 21.8%–32.6%. General population HCV prevalence ranges from 4.8% to 17%, with genotype 3a predominant. Most patients present with advanced HCC (Barcelona Clinic Liver Cancer [BCLC] stage C/D, 62.8%), limiting curative options. Barriers include lack of a national cancer registry, inadequate screening, and restricted access to therapies like transarterial chemoembolization (TACE) and sorafenib. Direct-acting antivirals (DAAs) have reduced HCV-related HCC incidence, but late diagnosis and healthcare disparities persist.
Conclusions: Pakistan’s HCC burden demands a paradigm shift toward national screening, decentralized treatment, and innovative technologies like AI-driven diagnostics. A national cancer registry and bold public health reforms are critical to align with global hepatitis elimination goals by 2030.
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Copyright (c) 2026 Sameed Qureshi, Kamran Amir Khan, Zuhra Naheed Khan, Aamir Wisal (Author)
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