Background Data on the contribution of hepatitis viruses to the burden of hepatocellular carcinoma (HCC) are essential for global hepatitis elimination. Objective To estimate the HCC burden attributable to HBV and HCV by country, region and globally. Design We performed a systematic review and meta-analysis between 1 October 2014 and 31 December 2023 using studies that reported the prevalence of both HBV and HCV in at least 20 patients with HCC. Pooled prevalence estimates by country were calculated to estimate regional and global HBV and HCV attributable fractions (AFs) and HCC-attributable age-standardised incidence rates (ASIRs). Results 857 eligible publications from 81 countries or territories were included. HBV and HCV prevalence among patients with HCC varied substantially by country and region. HBV AF was highest in Eastern Asia (70%), with HBV-attributable ASIRs of >10 per 100 000 observed in Mongolia and Viet Nam and was lowest in Northern Europe (6%). HCV AF was highest in Northern Africa (77%), and HCV-attributable ASIRs of >10 per 100 000 were observed in Egypt and Mongolia. Patients with HBV-related HCC were younger than patients with HCV-related HCC. Globally, HBV and HCV AFs were 52% and 21%, corresponding to 345 434 and 134 418 HCC cases, respectively, in 2022. Alcohol and/or metabolic dysfunction-associated steatotic liver disease were present in more than 30% of HCC in certain countries of Europe and South America. Conclusion HBV and HCV contribute to approximately three-quarters of the global HCC burden. These data can inform viral hepatitis prevention strategies. PROSPERO registration number CRD42023397708.
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