SERPINA1 and hepatocellular carcinoma: While HCV and alcoholic liver disease causes most of the HCC in Western countries, hepatitis B virus (HBV) infection is the leading cause in Southeast Asia and sub-Saharan Africa, where it is endemic.14 Other possible HCC risk factors include hereditary hemochromatosis, alpha1-antitrypsin deficiency, autoimmune hepatitis, certain porphyrias and Wilson’s disease.