Surial, Bernard; Wyser, Dominik; Béguelin, Charles; Ramírez Mena, Adrià; Rauch, Andri; Wandeler, Gilles (2021). Prevalence of cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis. Liver international, 41(4), pp. 710-719. Blackwell Munksgaard 10.1111/liv.14744
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BACKGROUND & AIMS
Chronic hepatitis B virus (HBV) infection accounts for 30-50% of cirrhosis related deaths in sub-Saharan Africa (SSA). Since HBV-related liver cirrhosis is an indication for immediate antiviral therapy and cancer surveillance, we aimed to estimate the prevalence of liver 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 liver cirrhosis in HBsAg-positive persons, which we estimated using random-effects meta-analysis. Risk factors for liver cirrhosis were explored using subgroup-analyses and multivariable meta-regression.
RESULTS
Of 2'129 articles identified, 17 met our eligibility criteria. The studies described 22 cohorts from 13 countries, including 13 cohorts (3'204 patients) with chronic HBV mono-infection and 9 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 liver cirrhosis was 4.1% (95% CI 2.6-6.4) among studies from primary care facilities or general population screening, 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 liver cirrhosis and age, sex, test used, or HIV-coinfection.
CONCLUSIONS
Depending on the setting, between 4% and 13% of HBV-infected individuals in SSA have liver cirrhosis and need immediate antiviral therapy. These estimates should be considered for HBV treatment strategies and resource allocation.
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