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Other risk cofactors of potential importance in the development of HCC include alcohol misuse and metabolic problems like diabetes mellitus, metabolic syndrome, and fatty liver. Certain HBV genotypes may increase HCC risk as well. Hosaka and colleagues10 demonstrated that of the 2 most common genotypes in Asia, genotype C is associated with a higher risk of HCC than genotype B. In addition, suboptimal antiviral therapy and reduced viral suppression is associated with a higher risk of HCC compared with more effective therapy. In this Kaplan-Meier curve of cumulative HCC incidence by type of nucleos(t)ide analogue therapy, risk of developing HCC was lower in those receiving entecavir (ETV) vs the older agent lamivudine, the latter being associated with greater drug resistance.10