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Galicia-Moreno et al. Hepatoma Res 2020;6:20 I http://dx.doi.org/10.20517/2394-5079.2019.36 Page 5 of 18

Table 3. HCV infections, genotypes and mortality rates in Latin America and the Caribbean
Viremic Most prevalent Population living with Mortality rates from Mortality rates from Mortality rates from
Country prevalence, genotype, 2015 HCV-related liver acute and chronic cirrhosis due to liver cancer due to
2015* cirrhosis (1000s), 2015 hepatitis C, 2013 hepatitis C, 2013 hepatitis C, 2013
Dominican 0.6% 1a (58.9%) 6.80 0.08 6.60 3.27
Republic
Chile 0.3% 1b (72.7%) 6.80 0.00 11.38 3.22
Cuba 0.3% 1b (81%) 4.30 0.00 4.19 2.96
Argentina 0.8% 1b (38.1%) 48.20 0.02 6.62 2.84
Mexico 0.4 % 1a (45.4%) 62.70 0.05 12.55 2.68
Brazil 0.9% 1b (33.4%) 267.00 0.04 5.93 2.46
Colombia 0.8% 1b (82.8%) 57.40 0.03 3.78 1.86
Venezuela 0.4% 1a (37%) 0.21 0.05 3.94 1.80
Peru 0.5% 1a (74%) 16.90 0.02 6.68 0.90
*2015 year-end estimate is a model output projection based on historic data. HCV: hepatitis C virus

Figure 3. Choropleth map of the fraction of liver cancer attributable to HCV in some Latin America and the Caribbean countries, 2012.
Pie charts represent the genotypes present in some of those countries and the proportion of cases that are related to each genotype.
Genotype distribution data are either taken from the literature or based on regional averages in the absence of country-specific data.
HCV: hepatitis C virus; AF: attributable fraction

ETIOLOGY AND RISK FACTORS IN HCC DEVELOPMENT
The etiology of HCC depends on the geographic location. For example, in countries where HCC is endemic
such as Africa, Asia and Alaska, the most common cause is HBV infection. In countries where the risk of
[17]
HCC is low, cirrhosis is the main cause of HCC in spite of the etiology .

The main risk factors associated with developing HCC are as follows.

Age
The risk of developing HCC is higher during the seventh decade of life. Nevertheless, HCC tends to affect
[18]
people in their sixties in Mexico .

Cirrhosis
[18]
This is the main risk factor for HCC . Several etiologic agents are implicated with cirrhosis development
including chronic viral hepatitis, alcohol consumption, hemochromatosis, metabolic diseases such as
[19]
nonalcoholic fatty liver disease, etc. In Mexico, the main risk factor for cirrhosis is alcohol consumption .
Long term studies have reported that 1%-8% of cirrhotic patients will develop HCC (3%-8% in patients
[2]
infected with HCV) .