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Page 2 of 18 Galicia-Moreno et al. Hepatoma Res 2020;6:20 I http://dx.doi.org/10.20517/2394-5079.2019.36

INTRODUCTION
Latin America is one of the most urbanized regions in the world, made up of 20 countries and 13
[1]
departments with an estimated population of 626 million .

In this and other regions with large populations, access to health care is the main impediment for early
[2]
diagnosis and correct treatment of HCC; and therefore, for the implementation of surveillance programs .
HCC is the most common cancer associated with chronic liver disease and cirrhosis, and is the second
[3]
leading cause of cancer-related deaths worldwide . Etiology factors for HCC varies according to its
[4]
geographical area , being the most reported causes of HCC around the world chronic hepatitis C and B
[5]
viruses (HCV, HBV) infections, and alcohol consumption . Recently, it has been considered that non-
[6]
alcoholic fatty liver disease could also be an important risk factor for HCC development .
Globally, liver cancer is the sixth cause of incidence and fourth in cancer-related mortality. New cases of liver
cancer in 2018 were 841,080 that correspond to 4.7% of all registered cancer cases. Worldwide in that same
[7]
year, there were 781,631 deaths caused by liver cancer, number that represent 8.2% of deaths in that year .
In 2018, Latin America registered an incidence of 38,400 HCC cases; 11,229 of which corresponded to
Central America, 24,248 to South America and 2,923 to the Caribbean, being more affected the masculine
[7]
gender. Brazil was the country with most patients with HCC, followed by Mexico, Argentina and Peru . On
the other hand, regarding mortality data, HCC was the main cause of death in Latin America and Caribbean
countries during 2018, affected mainly masculine gender, Brazil and Mexico were the countries in the LAC
[7]
region with the highest mortality . The incidence, mortality, cumulative risk data and prevalence for the
countries belonging to Latin America are shown in Table 1.

At present, many studies have been focused on studying the etiology, epidemiology, diagnosis tools, and
therapeutic options in Europe, Asia and North America. However, little is known about these issues in Latin
America. The aim of this work is to provide a comprehensive review about the current situation of HCC
of viral origin (HCV) in Latin American, showing information about diagnosis and therapeutic strategies
employed in this region.

EPIDEMIOLOGY OF CHRONIC HCV INFECTION IN RELATION TO HCC: PREVALENCE AND
MORTALITY
The main causes of HCC in different geographical areas around the world have been related to infective
[8]
agents such as HCV . Of the total number of cancer cases, HCV caused 160,000 cases of HCC in 2018,
which is equivalent to 7.1% of cases worldwide caused by infectious agents. Of these, 3900 were reported in
[7]
Central America, 7400 in South America and 782 cases in the Caribbean .

Other data show that in 2016, of 7.2 million people worldwide who were living with chronic hepatitis C, 57%
corresponded to Latin America and 3% were from the Caribbean [Figure 1 and Table 2] [9,10] . The number of
people diagnosed and treated for chronic HCV infection in the Americas is very low - only around 25% of
all cases are diagnosed but just 14% are from Latin America and the Caribbean. Approximately 301,000 were
treated in 2016, which is equivalent to only 16% of the diagnosed population in America, whereas in Latin
America and the Caribbean, just 5% were under treatment. Determining the precise number of patients with
[9]
known HCV status and receiving care has been difficult .
In 2013 in America, of 125,700 deaths due to HCV and HBV, 80% were attributable to HCV of which 39%
occurred in the Americas. Compared to 1990, the number of deaths has increased by 134%, and 8% since
[9]
2010 .