Vol.:(0123456789) 1 3 Archives of Virology https://doi.org/10.1007/s00705-019-04440-5 ORIGINAL ARTICLE Hepatitis viruses take advantage of traditional practices to increase the burden of hepatocellular carcinoma in Tunisia Ines Dhifallah 1,5  · 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 Received: 19 May 2019 / Accepted: 26 August 2019 © Springer-Verlag GmbH Austria, part of Springer Nature 2019 Abstract 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 tat- toos 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. Handling Editor: Ioly Kotta-Loizou. * Ines Dhifallah dhifallah.ines@yahoo.fr * Olfa Bahri bahri.olfa@planet.tn Marwa Khedhiri marwa.kehidiri@gmail.com Anissa Chouikha chouikhaanissa@gmail.com Ghassen Kharroubi kharroubighassen@gmail.com Walid Hammami Hammemi.walid12@gmail.com Amel Sadraoui amelsedraoui1@gmail.com Mohamed Msaddek Azzouz mmazzouz@rns.tn Nadia Maamouri nadiamaamouri1939@yahoo.fr Tahar Khalfallah tahar.khalfallah@rns.tn Henda Triki henda.triki@pasteur.rns.tn Pascal Pineau pascal.pineau@pasteur.fr 1 Laboratory of Clinical Virology, Pasteur Institute of Tunis 13, Place Pasteur, Le Belvedere PB 74, 1002 Tunis, Tunisia 2 Department of Gastroenterology B, La Rabta Hospital, Faculty of Medicine, University of Manar, Tunis, Tunisia 3 Department of Gastroenterology, Hospital of Tahar Maamouri, Faculty of Medicine, University of Manar, Tunis, Tunisia 4 Department of General Surgery, Hospital of Mongi Slim, La Marsa, Faculty of Medicine, University of Manar, Tunis, Tunisia 5 Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia 6 Faculty of Sciences of Tunis, University of Manar, Tunis, Tunisia 7 Laboratory of Medical Epidemiology, Pasteur Institute of Tunis, Tunis, Tunisia 8 Nuclear Organization and Oncogene Unit, INSERM U993, Pasteur Institue, Paris, France