Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Liver Int. 2021 Apr;41(4):710-719. doi: 10.1111/liv.14744. Epub 2020 Dec 12.
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.
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.
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.
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.
慢性乙型肝炎病毒（HBV）感染占撒哈拉以南非洲（SSA）肝硬化相关死亡人数的 30%-50%。由于 HBV 相关肝硬化是立即进行抗病毒治疗和癌症监测的指征，因此我们旨在估计 SSA 中未经治疗的慢性 HBV 感染患者中肝硬化的患病率。
我们对评估 SSA 中接受治疗的 HBV 感染个体的肝纤维化分期的已发表文章进行了系统评价。我们的主要结局是 HBsAg 阳性者中肝硬化的患病率，该患病率使用随机效应荟萃分析进行估计。使用亚组分析和多变量荟萃回归探讨了肝硬化的危险因素。
在 2129 篇文章中，有 17 篇符合我们的纳入标准。这些研究描述了来自 13 个国家的 22 个队列，包括 13 个慢性 HBV 单一感染队列（3204 例患者）和 9 个 HIV/HBV 合并感染队列（688 例患者）。使用瞬态弹性成像（10 个队列）、APRI 评分（11 个队列）和 Fibrotest（一个队列）评估肝纤维化。来自初级保健机构或一般人群的研究中肝硬化的总体患病率为 4.1%（95%置信区间 [CI]：2.6-6.4），而在转诊或三级保健机构进行的研究中为 12.7%（95% CI：8.6-18.3）（调整后的优势比 0.29，95% CI：0.15-0.56）。我们没有发现肝硬化与年龄、性别、使用的纤维化检测或 HIV 合并感染之间存在关联。
根据所处环境的不同，SSA 中 4%至 13%的 HBV 感染者患有肝硬化并需要立即进行抗病毒治疗。在规划 HBV 治疗策略和资源分配时，应考虑这些估计值。
