Chronic hepatitis B virus infection in the Asia–Pacific region and Africa: Review of disease progression

Lin, Xiao Yan; Robinson, Noah Jamie; Thursz, Mark; Rosenberg, D; Weild, A. R.; Pimenta, Jeanne M.; Hall, Andrew J.

doi:10.1111/j.1440-1746.2005.03813.x

Cited by 81 publications

(62 citation statements)

References 45 publications

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“…This is the first long-term follow-up of a population-based cohort of chronic HBV carriers in SSA 3 31 32. We confirmed that the age-standardised rate of HCC in the chronic carriers in this study (67.3/100 000) was much higher than in the general population in The Gambia (22.1/100 000),27 which highlights the importance of controlling chronic HBV infection to prevent HCC.…”

Section: Discussionsupporting

confidence: 81%

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

Shimakawa

Lemoine

Njai

et al. 2015

Gut

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150

130

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Background The natural history of chronic HBV infection in sub-Saharan Africa is unknown. Data are required to inform WHO guidelines that are currently based on studies in Europe and Asia. Methods Between 1974 and 2008, serosurveys were repeated in two Gambian villages, and an open cohort of treatment-naive chronic HBV carriers was recruited. Participants were followed to estimate the rates of hepatitis B e (HBeAg) and surface antigen (HBsAg) clearance and incidence of hepatocellular carcinoma (HCC). In 2012–2013, a comprehensive liver assessment was conducted to estimate the prevalence of severe liver disease. Results 405 chronic carriers (95% genotype E), recruited at a median age of 10.8 years, were followed for a median length of 28.4 years. Annually, 7.4% (95% CI 6.3% to 8.8%) cleared HBeAg and 1.0% (0.8% to 1.2%) cleared HBsAg. The incidence of HCC was 55.5/100 000 carrier-years (95% CI 24.9 to 123.5). In the 2012–2013 survey (n=301), 5.5% (95% CI 3.4% to 9.0%) had significant liver fibrosis. HBV genotype A (versus E), chronic aflatoxin B1 exposure and an HBsAg-positive mother, a proxy for mother-to-infant transmission, were risk factors for liver fibrosis. A small proportion (16.0%) of chronic carriers were infected via mother-to-infant transmission; however, this population represented a large proportion (63.0%) of the cases requiring antiviral therapy. Conclusions The incidence of HCC among chronic HBV carriers in West Africa was higher than that in Europe but lower than rates in East Asia. High risk of severe liver disease among the few who are infected by their mothers underlines the importance of interrupting perinatal transmission in sub-Saharan Africa

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Section: Discussionsupporting

confidence: 81%

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

Shimakawa

Lemoine

Njai

et al. 2015

Gut

Self Cite

150

130

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“…3) [33]. The rate of progression from chronic hepatitis to cirrhosis is 1-4% in China and Taiwan [34].…”

Section: Progression Of Liver Disease and Mortality Rates In Hepatitis Bmentioning

confidence: 98%

“…In Korea, the 5, 10, 15, and 20-year progression rates from chronic hepatitis to cirrhosis are 9, 23, 36, and 48% respectively [35]. Thereafter, progression of compensated to decompensated cirrhosis occurs at an annual rate of 3.2-4.6% [33]. In a Taiwanese study, the mean age at decompensation in cirrhotic patients was 57.2 years [36].…”

Section: Progression Of Liver Disease and Mortality Rates In Hepatitis Bmentioning

confidence: 99%

“…The annual rate of progression from the inactive carrier stage to HCC is 0.27-0.4%, from chronic hepatitis to HCC is 0.27-10%, Fig. 2 The clinical stages of hepatitis B [30] and from cirrhosis to HCC is 3-10% [33,37,38]. In Korea, the 5, 10, and 15-year rates of progression from chronic hepatitis to HCC is 2.7, 11, and 25% respectively, and the rate of progression from cirrhosis to HCC is 13, 27, and 42%, respectively [11].…”

Section: Progression Of Liver Disease and Mortality Rates In Hepatitis Bmentioning

confidence: 99%

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The Management of Chronic Hepatitis B in Asian Americans

et al. 2011

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Hepatitis B virus (HBV) infection is common with major clinical consequences worldwide. In Asian Americans, the HBsAg carrier rate ranges from 7 to 16%; HBV is the most important cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Patients are first diagnosed at different stages of clinical disease, which is categorized by biochemical and virologic tests. Patients at risk for liver complications should be identified and offered antiviral therapy. The two antiviral agents recommended for first-line treatment of chronic hepatitis B (CHB) are entecavir and tenofovir. The primary goal of therapy is sustained suppression of viral replication to achieve clinical remission, reverse fibrosis, and prevent and reduce progression to end-stage liver disease and HCC. Asian patients with chronic hepatitis, either HBeAg-positive or -negative, with HBV DNA levels >10(4) copies/mL (>2,000 IU/mL) and alanine aminotransferase (ALT) values above normal are candidates for antiviral therapy. HBeAg-negative patients with HBV DNA >10(4) copies/mL (>2,000 IU/mL) and normal ALT levels but who have either serum albumin ≤3.5 g/dL or platelet count ≤130,000 mm(3), basal core promoter mutations, or who have first-degree relatives with HCC should be offered treatment. Patients with cirrhosis and detectable HBV DNA must receive antiviral therapy. Considerations for treatment include pregnant women with high viremia, coinfected patients, and those requiring immunosuppressive therapy. In HBsAg-positive patients with risk factors, lifelong surveillance for HCC with alpha-fetoprotein testing and abdominal ultrasound examination at 6-month intervals is required. These recommendations are based on a review of relevant literature and the opinion of a panel of Asian American physicians with expertise in hepatitis B treatment.

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“… HBV – hepatitis B virus; ALT – alanine aminotransferase 1 Percentage of all chronically infected individuals who are aware of their infection 2 This value was estimated from 96 , and then calibrated to yield approximately 25% mortality from untreated liver disease 86, 97 . 3 Personal communication with physicians in China 4 Some therapies are discontinued if the therapy suppresses the virus. This parameter is the fraction of patients who continue on drug therapy after the therapy has suppressed the virus into a “durable response.”…”

Section: Calculation Of Optimal Vaccination Levelmentioning

confidence: 99%

Too Much of a Good Thing? When to Stop Catch-Up Vaccination

Hutton

Brandeau

2013

Med Decis Making

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During the 20th century, deaths from a range of serious infectious diseases decreased dramatically due to the development of safe and effective vaccines. However, infant immunization coverage has increased only marginally since the 1960s, and many people remain susceptible to vaccine-preventable diseases. “Catch-up vaccination” for age groups beyond infancy can be an attractive and effective means of immunizing people who were missed earlier. However, as newborn vaccination rates increase, catch-up vaccination becomes less attractive: the number of susceptible people decreases, so the cost to find and vaccinate each unvaccinated person may increase; additionally, the number of infected individuals decreases, so each unvaccinated person faces a lower risk of infection. This paper presents a general framework for determining the optimal time to discontinue a catch-up vaccination program. We use a cost-effectiveness framework: we consider the cost per quality-adjusted life year gained of catch-up vaccination efforts, as a function of newborn immunization rates over time and consequent disease prevalence and incidence. We illustrate our results with the example of hepatitis B catch-up vaccination in China. We contrast results from a dynamic modeling approach with an approach that ignores the impact of vaccination on future disease incidence. The latter approach is likely to be simpler for decision makers to understand and implement because of lower data requirements.

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Chronic hepatitis B virus infection in the Asia–Pacific region and Africa: Review of disease progression

Cited by 81 publications

References 45 publications

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

The Management of Chronic Hepatitis B in Asian Americans

Too Much of a Good Thing? When to Stop Catch-Up Vaccination

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