Hepatitis B treatment eligibility in West Africa: Uncertainties and need for prospective cohort studies

Abstract

Background & aims: While universal screening of hepatitis B virus (HBV) is recommended in high burden countries, little is known about the proportion of HBV-infected persons in need of antiviral therapy in these settings.

Methods: Prisoners in Senegal and Togo as well as female sex workers and men who have sex with men in Cote d'Ivoire were screened for HBV infection. All HBsAg-positive participants underwent transient elastography, alanine aminotransferase (ALT) and HBV viral load (VL) quantification. Individuals with cirrhosis or those aged >30 years with an HBV replication ≥20 000 IU/mL and elevated ALT were considered eligible for antiviral therapy.

Results: Of 1256 participants, 110 (8.8%) were HBsAg positive; their median age was 30 years [interquartile range: 25-33] and 96 (86.5%) were men. Three individuals (2.7%) had cirrhosis, while 28 (29.5%) of 94 participants with available measurements had an HBV VL ≥20 000 IU/mL. Overall, 11 (10.0%) subjects were considered eligible for immediate antiviral treatment (2.1% of participants in Dakar, 7.7% in Abidjan and 21.6% in Lome, P=.001) and 59 (53.4%) for close monitoring due to the presence of significant liver fibrosis, elevated ALT or significant HBV replication.

Conclusions: Among vulnerable populations in West Africa, a minority of HBV-infected individuals were eligible for immediate antiviral therapy. Prospective cohort studies are necessary to evaluate anti-HBV treatment eligibility facing the significant proportion of individuals with active chronic HBV infection.

Keywords: Africa; antiviral treatment; hepatitis B virus.

Figure 1. Proportion of HBV-infected participants eligible for antiviral treatment or in need of close monitoring according to the WHO guidelines* in Lome (Togo), Dakar (Senegal) and Abidjan (Cote d’Ivoire) 2013–2015 (n=110)

* Treatment eligible: patients presenting with cirrhosis (based on a transient elastography value ≥9.7 KPa) or an HBV viral load ≥20 000 IU/ml with an abnormal ALT (≥30 IU/L in men or ≥19 IU/L in women) if aged >30 years. Close monitoring considered if presence of at least one of the following elements; (i) HBV viral replication ≥2 000 IU/ml, (ii) significant fibrosis (≥F2 METAVIR score based on transient elastography) (iii) abnormal ALT level. Deferred treatment; none of the previous elements. †Men having sex with men, ‡Female sex workers, ∫Inmates