Does tobacco consumption impact the risk of developing hepatocellular carcinoma in patients with hepatitis B? – A systematic review Hepatitis B is a major global public health concern. The disease has a huge impact on healthcare systems as its chronicity in liver cirrhosis or hepatocellular carcinoma. Globally, World Health Organization estimates that 296 million people were living with chronic hepatitis B infection in 2019. The aim of this study was to identify if cigarette smoking is a potential risk factor for hepatocellular carcinoma initiation, partially through interaction with hepatitis B virus. The Systematic electronic search for articles published without a time limit included online articles of PubMed, Google Scholar, Medline with Full Text and Medscape, discussing the study aim. A total of 12 studies were identified using key word as Hepatitis B infection, liver cancer, hepatocellular carcinoma, smoking, cigarette, tobacco consumption. The categorization was done for the first author and year of article publishing, methodology and results. Based on the results of studies mediation modeling further indicated that viremia levels, may play a key mediating role in the path between smoking and HCC, in patients with hepatitis B infection. One of the studies included in the review, analyzed various dimensions of cigarette smoking, and the results all support the hypothesis that chronic smoking increases viremia/ALT levels. The finding that both former and current smokers were more likely than nonsmokers to have higher viral load suggests that smoking-induced immune changes can persist even after smoking cessation. In summary, tobacco consumption is an important cause of some diseases. Specifically, our study highlights the effect of smoking on the risk of Hepatitis B Virus related Hepatocellular carcinoma. We strongly suggest that healthcare practitioners should educate and train patient with chronic hepatitis B to quit smoking, in order to avoid the onset of liver cancer.