Interaction between hepatitis B, hepatitis C and smoking in the development of hepatocellular carcinoma: a systematic review and meta-analysis.

This meta-analysis examines the combined effects of hepatitis B virus (HBV), hepatitis C virus (HCV), and smoking on the development of hepatocellular carcinoma (HCC). Analyzing 32 observational studies with 22,282 participants, the study found that HBV and smoking together increase HCC risk by nearly 20-fold (OR=19.81), HCV and smoking by about 25-fold (OR=24.86), and HBV and HCV coinfection by over 32-fold (OR=32.58). The findings highlight a significant synergistic interaction among these factors, suggesting that integrated strategies including viral hepatitis prevention, treatment, and smoking cessation could reduce HCC incidence. Limitations include variability in study designs, potential confounders not accounted for, and inconsistent smoking data, indicating a need for further targeted research.