St Mary's Hospital Lacor, Gulu Province, Uganda.
Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, UK.
Trans R Soc Trop Med Hyg. 2019 Jan 1;113(1):11-17. doi: 10.1093/trstmh/try117.
Chronic hepatitis B infection affects 240 million people, with the highest prevalence in Africa and Asia, and results in 700 000 deaths annually. Access to diagnostics, particularly for hepatitis B virus viral load quantification (HBV DNA), is a major barrier to treatment. We aimed to test World Health Organization guidelines for hepatitis B management in resource-limited settings.
We compared treatment allocation with and without the use of HBV DNA in a cohort in Uganda. Hepatitis B surface antigen test-positive, human immunodeficiency virus-negative, treatment-naïve adults were recruited prospectively. Following liver ultrasound and routine haematological and biochemical tests, preliminary allocations into treatment and observation groups were made. HBV DNA was performed for each participant and final treatment decisions were made and compared with preliminary allocations.
Full assessment was completed for 100 participants; treatment was indicated in 20. Assessment without HBV DNA identified patients for treatment with a positive predictive value of 88.2% and a negative predictive value of 94% compared with assessment using HBV DNA.
Where HBV DNA is unavailable, patients with hepatitis B can be assessed by liver ultrasound and routine laboratory tests. These findings will enable physicians in resource-limited settings to initiate treatment more readily and inform policy with regards to viral hepatitis elimination.
慢性乙型肝炎感染影响全球 2.4 亿人，在非洲和亚洲发病率最高，每年导致 70 万人死亡。获得诊断，特别是乙型肝炎病毒载量定量（HBV DNA）检测，是治疗的主要障碍。本研究旨在检测世界卫生组织（WHO）在资源有限地区管理乙型肝炎的指南。
我们在乌干达的队列中比较了有和没有使用 HBV DNA 的治疗分配情况。前瞻性招募乙型肝炎表面抗原阳性、人类免疫缺陷病毒阴性、初治的成年患者。进行肝脏超声和常规血液学及生化检查后，初步将患者分配到治疗组和观察组。对每位患者进行 HBV DNA 检测，然后根据检测结果做出最终治疗决策，并与初步分配进行比较。
100 名患者完成了全面评估；20 名患者需要治疗。与使用 HBV DNA 相比，不使用 HBV DNA 评估可以确定需要治疗的患者，其阳性预测值为 88.2%，阴性预测值为 94%。
在无法获得 HBV DNA 的情况下，可以通过肝脏超声和常规实验室检查来评估乙型肝炎患者。这些发现将使资源有限地区的医生更容易启动治疗，并为消除病毒性肝炎的政策提供信息。
