Hepatocellular carcinoma (HCC) is a leading cause of mortality in sub-Saharan Africa (SSA). This systematic review aimed to appraise all population-based studies describing the management and outcomes of HCC in SSA. A systematic review based on a search in PubMed, PubMed Central, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), AfricaWide and Cochrane up to June 2023 was performed. PRISMA guidelines for systematic reviews were followed. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration no: CRD42022363955). Thirty-nine publications from 15 of 48 SSA countries were identified; 3989 patients were studied. The majority (74%) were male, with median ages ranging from 28 to 54 years. Chronic Hepatitis B infection was a leading aetiology and non-cirrhotic HCC was frequently reported. Curative treatment (liver resection, transplantation and ablation) was offered to 6% of the cohort. Most patients (84%) received only best supportive care (BSC), with few survivors at one year. The majority of SSA countries do not have data reporting outcomes for HCC. Most patients receive only BSC, and curative treatment is seldom available in the region. Outcomes are poor compared to high-income countries.

Background: Infection with HIV increases the risk of developing hepatocellular carcinoma, and the albumin–bilirubin grade assesses liver function and has been shown to be prognostic. We evaluated the albumin–bilirubin score/grade and the HIV status of hepatocellular carcinoma patients in Zimbabwe and explored the impact on median survival. Methods: A 10-year retrospective observational study of hepatocellular carcinoma patients was conducted at a single tertiary-level cancer center in Harare, Zimbabwe. Survival probabilities were estimated using the Kaplan–Meier method, and differences between groups were compared using the log-rank test and Cox proportional hazards regression. Results: A total of 95 participants were evaluated, of whom 72.6% were male. Most HCC cases were diagnosed using imaging and serum alpha-fetoprotein, with 59% presenting at Barcelona Clinic Liver Cancer stage C or D. Compared with patients who were HIV-negative, patients who were HIV-positive (OR 2.2; 95% CI 1.54–5.26, p = 0.0008) or had an unknown HIV status (OR 4.2; 95% CI 2.2–8; p < 0.0001) had higher odds of being at ALBI grade 3 at the time of HCC diagnosis. ALBI grade 1 patients had better median survival compared to grade 2 and 3 patients, though this result was statistically insignificant (grade 2: HR = 1.45, 95% CI: 0.30–7.13; grade 3: HR = 1.47, 95% CI: 0.28–7.60). Regarding HIV status, median survival was 2.4 months for HIV-positive patients and 2.6 months for HIV-negative patients (p = 0.51); HIV positivity was not significantly associated with median survival (HR = 1.50, 95% CI: 0.46–4.91). Only 30.5% of patients received cancer therapy, all of which was palliative, with no observed survival benefit. Conclusions: The majority of hepatocellular carcinoma patients in Zimbabwe were diagnosed at an advanced stage, with hepatitis B or C viral infections and alcohol consumption identified as primary risk factors. Median survival rates were low. Neither HIV infection nor ALBI score grading had a significant impact on median survival.