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Meta-Analysis
. 2021 Apr;41(4):710-719.
doi: 10.1111/liv.14744. Epub 2020 Dec 12.

Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis

Bernard Surial  1 , Dominik Wyser  1 , Charles Béguelin  1 , Adrià Ramírez-Mena  1 , Andri Rauch  1 , Gilles Wandeler  1   2
Affiliations
Meta-Analysis

Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis

Bernard Surial et al. Liver Int. 2021 Apr.

Abstract

Background & aims: Chronic hepatitis B virus (HBV) infection accounts for 30%-50% of cirrhosis related deaths in sub-Saharan Africa (SSA). Since HBV-related cirrhosis is an indication for immediate antiviral therapy and cancer surveillance, we aimed to estimate the prevalence of cirrhosis among treatment-naïve patients with chronic HBV infection in SSA.

Methods: We performed a systematic review of published articles which evaluated liver fibrosis stage among treatment-naïve HBV-infected individuals who presented to care in SSA. Our primary outcome was the prevalence of cirrhosis in HBsAg-positive persons, which was estimated using random-effects meta-analysis. Risk factors for cirrhosis were explored using subgroup-analyses and multivariable meta-regression.

Results: Of 2129 articles identified, 17 met our eligibility criteria. The studies described 22 cohorts from 13 countries, including 13 cohorts (3204 patients) with chronic HBV mono-infection and nine cohorts (688 patients) with HIV/HBV-coinfection. Liver fibrosis was assessed using transient elastography (10 cohorts), APRI score (11 cohorts), and Fibrotest (one cohort). The pooled prevalence of cirrhosis was 4.1% (95% confidence interval [CI] 2.6-6.4) among studies from primary care facilities or general population, compared to 12.7% (95% CI 8.6-18.3) in studies performed in referral or tertiary care facilities (adjusted odds ratio 0.29, 95% CI 0.15-0.56). We found no association between cirrhosis and age, gender, fibrosis test used or HIV-coinfection.

Conclusions: Depending on the setting, between 4% and 13% of HBV-infected individuals in SSA have cirrhosis and need immediate antiviral therapy. These estimates should be considered when planning HBV treatment strategies and resource allocation.

Keywords: Hepatitis B virus; Sub-Saharan Africa; antiviral treatment; cirrhosis; liver fibrosis; systematic review.

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Conflict of interest statement

BS reports support to his institution for travel grants from Gilead Sciences. AR reports support to his institution for advisory boards and/or travel grants from Janssen‐Cilag, MSD, Gilead Sciences, and Abbvie, and an unrestricted research grant from Gilead Sciences. All remuneration went to his home institution and not to AR personally, and all remuneration was provided outside the submitted work. GW reports support to his home institution for advisory boards and/or travel grants from MSD, Gilead Sciences and Abbvie, and an unrestricted research grant from Gilead Sciences. DW, CB and ARM report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Overview of cohorts contributing data to the meta‐analysis. Countries with available data (A) and distribution of cohorts with data from primary care/general population cohorts or referral/teaching hospitals (B)
FIGURE 2
FIGURE 2
Proportion of individuals with liver cirrhosis, stratified by cohort category
FIGURE 3
FIGURE 3
Proportion of individuals with liver cirrhosis, stratified by HIV infection status (A) and by fibrosis test used(B).
See this image and copyright information in PMC

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