Key findings include a high prevalence of APRI score indicating significant fibrosis/cirrhosis in ART-naïve individuals particularly among HIV/HBV-co-infected individuals and a regression of APRI to <1.5 after 12-24 months of ART in the majority of participants with APRI score indicating significant fibrosis, irrespective of HBV status.
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.
Over 10% of people living with HIV (PLWH) in West Africa also have chronic hepatitis B virus (HBV) infection, the leading cause of liver cirrhosis and cancer in the region. 1 HIV infection has a profound impact on the natural history of HBV, including the acceleration of the progression to end-stage liver disease and the increase in liverrelated mortality. 2,3 Tenofovir-containing antiretroviral therapy
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