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Figure 2. Mechanisms and factors behind HBV-HIV coinfection in the development of cirrhosis and hepatocellular carcinoma in Africa. Flow chart detailing how similar routes of transmission and limited health resources increase the prevalence of HIV-HBV coinfection in Africa. HBV and HIV both induces cirrhosis by damaging liver cells by multiple mechanism, including chronic inflammation in the case of HBV and multiple metabolic alterations in the case of HIV. In addition, HBV by itself can also induce HCC in absence of cirrhosis by direct DNA mutagenesis thought to be related to viral insertion and HIV can increase the risk of HCC by itself by decreasing immune-surveillance (affecting NK cells) and by modulation CCR5, which has been involved in HCC formation.