The WHO guidelines for chronic hepatitis B fail to detect half of the patients in need of treatment in Ethiopia

Aberra, Hanna; Desalegn, Hailemichael; Berhe, Nega; Mekasha, Bitsatab; Medhin, Girmay; Gundersen, Svein Gunnar; Johannessen, Asgeir

doi:10.1016/j.jhep.2019.01.037

Cited by 51 publications

(46 citation statements)

References 28 publications

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“…Compared to EASL 2017, WHO had very low sensitivity to identify HBV monoinfected patients who needed AVT. Among the 25 who met EASL criteria, only 10 (40%) met WHO criteria, similar to a recent study in Ethiopia [26]. Unlike the Ethiopian study, where many patients had complications of HBV at baseline, including decompensated or compensated cirrhosis, our sample was population-based and importantly no patient had decompensated cirrhosis, one of the WHO criterion.…”

Section: Discussionsupporting

confidence: 54%

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

et al. 2020

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IntroductionWe evaluated antiviral therapy (AVT) eligibility in a population-based sample of adults with chronic hepatitis B virus (HBV) infection in Zambia. Materials and methodsUsing a household survey, adults (18+ years) were tested for hepatitis B surface antigen (HBsAg). Sociodemographic correlates of HBsAg-positivity were identified with multivariable regression. HBsAg-positive individuals were referred to a central hospital for physical examination, elastography, and phlebotomy for HBV DNA, hepatitis B e antigen, serum transaminases, platelet count, and HIV-1/2 antibody. We determined the proportion of HBV monoinfected adults eligible for antiviral therapy (AVT) based on European Association for the Study of the Liver (EASL) 2017 guidelines. We also evaluated the performance of two alternative criteria developed for use in sub-Saharan Africa, the World Health Organization (WHO) and Treat-B guidelines. ResultsAcross 12 urban and 4 rural communities, 4,961 adults (62.9% female) were tested and 182 (3.7%) were HBsAg-positive, 80% of whom attended hospital follow-up. HBsAg-positivity was higher among men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 0.99-1.87) and with decreasing income (AOR, 0.89 per household asset; 95% CI, 0.81-0.98). Trends toward higher HBsAg-positivity were also seen at ages 30-39 years (AOR, 2.11; 95% CI, 0.96-4.63) and among pregnant women (AOR, 1.74; 95% CI, 0.93-3.25). Among HBV monoinfected individuals (i.e., HIV-negative) evaluated for AVT, median age PLOS ONE | https://doi.

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Section: Discussionsupporting

confidence: 54%

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

et al. 2020

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“…are not available in many lower-and middle-income country settings, and there is a call for algorithms to be simplified [59,60]. Relaxing the stringency of assessment for treatment may also have the added benefit of reducing complications from HBV progression, as not all individuals at high risk of cirrhosis or hepatocellular carcinoma (HCC) are detected by current algorithms [61]. Therefore, adopting a universal T&T strategy for HBV would need to be carefully evaluated to consider challenges and risks as well as benefits.…”

Section: Plos Medicinementioning

confidence: 99%

Hepatitis B virus seroepidemiology data for Africa: Modelling intervention strategies based on a systematic review and meta-analysis

et al. 2020

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Background International Sustainable Development Goals (SDGs) for elimination of hepatitis B virus (HBV) infection set ambitious targets for 2030. In African populations, infant immunisation has been fundamental to reducing incident infections in children, but overall population prevalence of chronic hepatitis B (CHB) infection remains high. In high-prevalence populations, adult catch-up vaccination has sometimes been deployed, but an alternative Test and Treat (T&T) approach could be used as an intervention to interrupt transmission. Universal T&T has not been previously evaluated as a population intervention for HBV infection, despite high-profile data supporting its success with human immunodeficiency virus (HIV). Methods and findings We set out to investigate the relationship between prevalence of HBV infection and exposure in Africa, undertaking a systematic literature review in November 2019. We identified published seroepidemiology data representing the period 1995-2019 from PubMed and Web of Science, including studies of adults that reported prevalence of both hepatitis B

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“…Our results strongly suggest that the higher cutoffs recommended by the World Health Organization are not appropriate for CHC care in Ethiopia and possibly other SSA countries. It is unclear why the APRI cutoff needs adjustment in African viral hepatitis cohorts, [10][11][12] but biological differences cannot be excluded because the validation of APRI and FIB-4 has been carried out mainly among Caucasian and Asian patients. 4 Our findings have certain implications for HCV treatment initiation in resource-limited settings to reduce CHC-related mortality and advance progress toward hepatitis elimination.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Noninvasive Markers of Liver Fibrosis in Patients With Chronic Hepatitis C in Ethiopia

et al. 2020

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Of an estimated 71 million individuals with chronic hepatitis C virus (HCV) infection worldwide, 10 to 15 million are estimated to live in sub-Saharan Africa (SSA). 1 Despite recommendations for a "treat-all" public health approach to reach elimination by 2030, 2,3 national treatment programs in many African countries and other resource-constrained settings still might have to prioritize HCV treatment for individuals with advanced liver fibrosis and cirrhosis. In settings with limited resources, there is little or no access to liver biopsy and transient elastography (TE) to determine fibrosis stage. Noninvasive tests, such as the aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) score, have demonstrated acceptable sensitivity and specificity to detect advanced fibrosis and cirrhosis in chronic hepatitis C (CHC). 4 However, there are limited data on the performance of these tests in SSA, where endemic conditions such as malaria, schistosomiasis, and human immunodeficiency Abbreviations: ALT, alanine aminotransferase; APRI, aspartate aminotransferase-to-platelet ratio index; AST, aspartate aminotransferase; AUROC, area under the receiver operating characteristic curve; CHC, chronic hepatitis C;

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The WHO guidelines for chronic hepatitis B fail to detect half of the patients in need of treatment in Ethiopia

Cited by 51 publications

References 28 publications

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

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

Hepatitis B virus seroepidemiology data for Africa: Modelling intervention strategies based on a systematic review and meta-analysis

Assessment of Noninvasive Markers of Liver Fibrosis in Patients With Chronic Hepatitis C in Ethiopia

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