Aflatoxin B₁ (AFB₁), the most potent and widespread mycotoxin produced by Aspergillus flavus and Aspergillus parasiticus, poses a significant global threat to food safety and human health, with chronic exposure strongly linked to hepatocellular carcinoma (HCC). While physical and chemical detoxification approaches exist, their limitations have led to an increased interest in biological strategies, particularly probiotic interventions. In this review, we synthesize current in vivo and clinical evidence on the ability of probiotic lactic acid bacteria—including Lactobacillus casei Shirota, Lactobacillus rhamnosus GG, Lactobacillus rhamnosus LC705, Lactococcus lactis, and selected Bifidobacterium species—to reduce AFB₁ absorption and toxicity. We summarize mechanistic insights into cell wall adsorption, gut microbiota modulation, intestinal barrier protection, and antioxidant enhancement. Clinical trials have shown reductions in AFB₁ biomarkers following probiotic supplementation, supporting their translational potential for human health. However, clinical evidence remains limited by small sample sizes, short intervention periods, and variability in endpoints. Collectively, this review consolidates mechanistic, preclinical, and clinical findings to position probiotic lactic acid bacteria as promising biological countermeasures against AFB1-induced hepatocellular carcinoma.