Aflatoxins, Hepatitis B Virus, and Hepatocellular Carcinoma

To the Editor: Blumberg and London clearly summarized the several lines of data that support the hypothesis that primary carcinoma is related to persistent infection with hepatitis B virus (HBV) (March 26 issue).¹ However, they do not discuss the very high incidence of aflatoxin contamination of foods, which occurs in many of the same areas of the world where there is a high carriage rate of HBV.² Aflatoxins (and other mycotoxins) may have a primary or secondary role in the development of primary hepatic carcinoma. They depress cellular immunity and thus may enhance a tendency toward persistent HBV infection, or.