Jaquet Antoine, Muula Guy, Ekouevi Didier K, Wandeler Gilles
University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219 Bordeaux, France.
Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.
Curr Epidemiol Rep. 2021 Sep;8(3):89-96. doi: 10.1007/s40471-021-00273-6. Epub 2021 Jul 31.
The purpose of our review was to summarize current recommendations on testing strategies, antiviral therapy eligibility and monitoring, and prevention of mother-to-child transmission of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and to highlight major research gaps in low and middle-income countries (LMIC), with a particular focus on sub-Saharan Africa (SSA).
While data on the prevalence of HBV and HCV infections in LMIC are increasing, current knowledge on liver-related complications as well as on treatment outcomes remains limited. Furthermore, very little information is available on the feasibility and cost-effectiveness of large-scale testing and management strategies in high-prevalence settings. The availability of policy-relevant data is particularly scarce in SSA, which accounts for a significant part of the global burden of chronic viral hepatitis.
Current recommendations on the management and monitoring of chronic viral hepatitis rely mainly on data from high-income settings. The global elimination of viral hepatitis will only be achieved if prevention, testing, and treatment strategies tailored to specific LMIC are implemented. In order to inform scalable and cost-effective interventions, dedicated research initiatives have to be undertaken. Future studies will have to include the evaluation of innovative testing strategies, the validation of simplified methods to diagnose liver cirrhosis and hepatocellular carcinoma, and the monitoring of long-term treatment outcomes and toxicity. In addition, national plans to achieve the elimination of HBV mother-to-child transmission are urgently needed, including effective ways to test pregnant women, treat those who are eligible, and ensure birth dose vaccination is given to all newborns.
我们综述的目的是总结关于慢性乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染的检测策略、抗病毒治疗资格与监测以及预防母婴传播的当前建议，并突出低收入和中等收入国家（LMIC）的主要研究差距，特别关注撒哈拉以南非洲（SSA）。
虽然LMIC中HBV和HCV感染患病率的数据在增加，但目前关于肝脏相关并发症以及治疗结果的知识仍然有限。此外，关于高流行环境中大规模检测和管理策略的可行性和成本效益的信息非常少。在占全球慢性病毒性肝炎负担很大一部分的SSA，与政策相关的数据尤其稀缺。
目前关于慢性病毒性肝炎管理和监测的建议主要依赖于高收入环境的数据。只有实施针对特定LMIC量身定制的预防、检测和治疗策略，才能在全球消除病毒性肝炎。为了为可扩展且具有成本效益的干预措施提供信息，必须开展专门的研究倡议。未来的研究将必须包括对创新检测策略的评估、对诊断肝硬化和肝细胞癌的简化方法的验证，以及对长期治疗结果和毒性的监测。此外，迫切需要国家计划来实现消除HBV母婴传播，包括有效检测孕妇、治疗符合条件者以及确保所有新生儿接种出生剂量疫苗的方法。
