Archives of Virology

, Volume 165, Issue 1, pp 33–42 | Cite as

Hepatitis viruses take advantage of traditional practices to increase the burden of hepatocellular carcinoma in Tunisia

  • Ines DhifallahEmail author
  • Marwa Khedhiri
  • Anissa Chouikha
  • Ghassen Kharroubi
  • Walid Hammami
  • Amel Sadraoui
  • Mohamed Msaddek Azzouz
  • Nadia Maamouri
  • Tahar Khalfallah
  • Henda Triki
  • Pascal Pineau
  • Olfa BahriEmail author
Original Article


Hepatocellular carcinoma (HCC) is a major public health issue in Africa. In Tunisia, hepatitis B virus (HBV) is known to be an important risk factor for HCC in the south of the country, but the role played by hepatitis C virus (HCV) still remains unclear. The aim of the current case-control study was to identify risk factors for HCC development in the northern part of the country. Clinical and biological data including viral hepatitis status (serological and molecular) and non-infectious risk factors from 73 patients with HCC and 70 control subjects without hepatic diseases were collected. The mean age of the patients was 63 ± 10 years, and the ratio of males to females was 1.1. HCC occurred in cirrhotic liver in 72.0% of the cases. HCV infection was the dominant risk factor (64.3% of cases); the presence of HBV was observed in 53.4% of the cases. Occult hepatitis B and C were implicated, respectively, in 30.1% and 9.6% of the cases. HCV genotype 1b was predominant. Patients originating from western Tunisia formed a homogeneous group, characterized by significantly higher rates of tattoos or scarifications (83%) and HCV infection (80%) than those from other parts of the country. Chronic HCV infection is currently the primary risk factor for HCC in Tunisia; HBV infection remains frequent in its overt or occult infection forms. Traditional esthetic practices apparently contribute to increasing the burden of terminal liver diseases in western Tunisia.



This study was supported by the “Tunisian Secretariat for Scientific Research and Technology SERST for the Tunisian part of the study (LR: Epidémiologie et diversité génétique des virus hépatiques et des entérovirus, Contract: LR11SP09)”.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Ines Dhifallah
    • 1
    • 5
    Email author
  • Marwa Khedhiri
    • 1
    • 6
  • Anissa Chouikha
    • 1
  • Ghassen Kharroubi
    • 7
  • Walid Hammami
    • 1
  • Amel Sadraoui
    • 1
  • Mohamed Msaddek Azzouz
    • 3
  • Nadia Maamouri
    • 2
  • Tahar Khalfallah
    • 4
  • Henda Triki
    • 1
  • Pascal Pineau
    • 8
  • Olfa Bahri
    • 1
    Email author
  1. 1.Laboratory of Clinical VirologyPasteur Institute of Tunis 13TunisTunisia
  2. 2.Department of Gastroenterology B, La Rabta Hospital, Faculty of MedicineUniversity of ManarTunisTunisia
  3. 3.Department of Gastroenterology, Hospital of Tahar Maamouri, Faculty of MedicineUniversity of ManarTunisTunisia
  4. 4.Department of General Surgery, Hospital of Mongi Slim, La Marsa, Faculty of MedicineUniversity of ManarTunisTunisia
  5. 5.Faculty of Sciences of BizerteUniversity of CarthageTunisTunisia
  6. 6.Faculty of Sciences of TunisUniversity of ManarTunisTunisia
  7. 7.Laboratory of Medical EpidemiologyPasteur Institute of TunisTunisTunisia
  8. 8.Nuclear Organization and Oncogene UnitINSERM U993, Pasteur InstitueParisFrance

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