Chu YJ, et al. - Researchers assessed the HCC risk associated with aflatoxin B₁ (AFB₁) in hepatitis C virus (HCV) -infected and those without hepatitis B virus (HBV) and HCV infection (non-B-non-C) in this case-control study nested in a community-based cohort. AFB₁ exposure was identified as a contributor to HCC development in those with significant risk factors for cirrhosis including alcohol and HCV infection.

• Researchers measured baseline serum AFB₁-albumin adduct levels in 100 HCC cases and 1767 controls seronegative for anti-HCV and HBsAg (non-B-non-C), and another 103 HCC cases and 176 controls who were anti-HCV-seropositive and HBsAg-seronegative.
• They used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs).

• In non-B-non-C (p=0.0162) and HCV-infected participants (p < 0.0001), those with higher serum AFB₁-albumin adduct levels had significantly shorter follow-up time to newly developed HCC, as observed during 20 years of follow-up.
• Within 8 years of follow-up, HCV infection and AFB₁ exposure were shown to be independent risk factors for HCC.
• In non-B-non-C participants with habitual alcohol consumption [crude OR (95% CI) for high vs low/undetectable levels, 4.22 (1.16–15.37)] and HCV-infected participants [3.39 (1.31–8.77)], researchers observed a significant association of elevated serum AFB₁-albumin adduct levels with an increased risk of HCC newly developed within 8 years of follow-up, whereas, this was not found in non-B-non-C participants without alcohol drinking habit.
• After adjustment for other HCC predictors, AFB₁ exposure remained an independent risk predictor for HCV-related HCC (multivariate-adjusted OR [95% CI], 3.65 [1.32–10.10]).