Stage of disease in hepatitis B virus infection in Zambian adults is associated with large cell change but not well defined using classic biomarkers

Abstract

BackgroundHepatocellular malignancy in young adults is a prominent feature of hepatitis B virus (HBV) infection in southern Africa. Here we report a cross-sectional study of liver pathology correlated with biomarkers in adults with HBV infection in Zambia.MethodsWe analysed liver biopsies from Zambian patients with persistent HBV infection.ResultsWe analysed 104 patients with HBV infection and evidence of liver disease. We obtained liver biopsies from 53 adults; of these, 12 (23%) were hepatitis B e antigen seropositive. The genotype was evenly distributed between A and E. One biopsy showed malignancy. Stage was 3 or more in 11 of 52 (21%) biopsies free of malignancy and lobular inflammation was found in 50 (94%). Neither alanine aminotransferase (ALT) nor the γ-glutamyl transferase:platelet ratio (GPR) were correlated with the stage of disease but were correlated with total Ishak score (ρ=0.47, p=0.0004 and ρ=0.33, p=0.02, respectively). Large cell change was observed in 10 of 11 biopsies with fibrosis stage 3 or more and 16 of 41 with early disease (p=0.005). Serum α-fetoprotein was elevated, although still within the normal range, in patients with large cell change (median 3.6 [interquartile range {IQR} 1.6–5.1]) compared with those without (1.7 [IQR 1.0–2.8]; p=0.03). Neither ALT nor GPR predicted large cell change.ConclusionsLarge cell change was common in young HBV-infected adults in Zambia. Only serum α-fetoprotein was identified as a biomarker of this phenotype.

Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia

“…However, we also noted that our HBV monoinfected sample had higher proportions with ALT >40 U/L and HBV DNA >2,000 IU/ml than the Gambian sample. Differences in the proportion needing therapy may be due to the sample age, as PROLIFICA recruited a slightly older population (median age of 38 years) or due to HBV genotype, since A1 is more common in Zambia [23,24] than the Gambia where E predominates, and genotype A1 was linked with more severe disease compared to E [11]. Treatment of HBV in those who need it is one of the 2030 global hepatitis targets [25]; therefore, estimates around the proportion who need therapy are critical to inform global strategies to diagnose and link individuals to care and AVT.…”

“…was 31 years, 24.6% were HBeAg-positive, and 27.9% had HBV DNA >2,000 IU/ml. AVTeligibility was 17.0% by EASL, 10.2% by WHO, and 31.1% by Treat-B.…”

Diagnostic performance of non-invasive fibrosis markers for chronic hepatitis B in sub-Saharan Africa: a Bayesian individual patient data meta-analysis

“…Cohorts represented by HEPSANET group members were described in 21 articles. 11,13,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] We contacted corresponding authors from the remaining 3 articles, [43][44][45] and all authors agreed to contribute individual patient data. We additionally included unpublished data from three sites (Cape Town, South Africa; Thiès, Senegal; and Dakar, Senegal) and data from one additional study published since the search was conducted from Malawi.…”