Although viral loads are known to influence the development of hepatitis B virus-induced hepatocellular carcinoma in a number of populations, little information is available in the Black African population. Black African patients with hepatocellular carcinoma differ from those in other populations in having a lower frequency of e antigen-positivity and in other respects that might affect viral loads. Hepatitis B viral loads were measured using real-time polymerase chain reaction assay in 124 Black Africans with hepatocellular carcinoma and compared with those in 125 Black adult asymptomatic viral carriers. The geometric mean viral load in the cancer patients was 553,618 copies/ml (95% CI 301,953–1,015,033 copies/ml), with 62.1% having loads >1 × 105 copies/ml and 87.1% >1 × 104 copies/ml, whereas that in the carriers was 16,084 copies/ml (95% CI 9,184–28,168 copies/ml), with only 15.2% having values >1 × 105 copies/ml and 49.6% >1 × 104 copies/ml (P < 0.001 in each instance). Mean viral load was significantly higher in e antigen-positive than e antigen-negative cancer patients (5,905,357 copies/ml [1,362,847–25,588,520] cf 238,173 copies/ml [97,200–685,730]: P < 0.001) after adjusting for age and sex. No statistically significant difference existed between patients in different age groups, in men and women, or in patients infected with genotype A or D after adjusting for the other variables. Conclusion: Black Africans with hepatocellular carcinoma have high hepatitis B viral loads in spite of the relative infrequency of e antigen-positivity. J. Med. Virol. 81:1525–1530, 2009. © 2009 Wiley-Liss, Inc.