Chronic hepatitis B virus infection in the Asia–Pacific region and Africa: Review of disease progression

Abstract

Countries in the the Asia-Pacific region and Africa tend to have the highest prevalence of hepatitis B infection worldwide. Hepatitis B infection progresses from an asymptomatic persistently infected status to chronic hepatitis B, cirrhosis, decompensated liver disease and/or hepatocellular carcinoma. The aim of this review was to summarize rates and risk factors for progression between disease states in the Asia-Pacific region and Africa. A literature search was conducted employing MEDLINE and EMBASE (1975-2003) using the following key words: hepatitis B, natural history, disease progression, cirrhosis, hepatocellular carcinoma, mortality, Africa and the Asia-Pacific region. Bibliographies of articles reviewed were also searched. Ranges for annual progression rates were: (i) asymptomatic persistent infection to chronic hepatitis B, 0.84-2.7%; (ii) chronic hepatitis B to cirrhosis, 1.0-2.4%; and (iii) cirrhosis to hepatocellular carcinoma, 3.0-6.6%. Patients with asymptomatic persistent infection and chronic hepatitis B had relatively low 5-year mortality rates (<4%); rates (>50%) were much higher in patients with decompensated liver disease and hepatocellular carcinoma. No data were found for progression rates in African populations. Hepatitis B e antigen was a risk factor for chronic hepatitis B, and bridging hepatic necrosis in chronic hepatitis B increased the risk of cirrhosis. Risk factors for hepatocellular carcinoma included cirrhosis, co-infection with hepatitis C virus, and genetic and environmental factors. In this review, wide ranges of disease progression estimates are documented, emphasizing the need for further studies, particularly in Africa, where progression rates are largely not available. Summarizing information on factors associated with disease progression should assist in focusing efforts to arrest the disease process in those at most risk.

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

“…This is the first long-term follow-up of a population-based cohort of chronic HBV carriers in SSA 3 31 32. We confirmed that the age-standardised rate of HCC in the chronic carriers in this study (67.3/100 000) was much higher than in the general population in The Gambia (22.1/100 000),27 which highlights the importance of controlling chronic HBV infection to prevent HCC.…”

The Management of Chronic Hepatitis B in Asian Americans

“…3) [33]. The rate of progression from chronic hepatitis to cirrhosis is 1-4% in China and Taiwan [34].…”

“…In Korea, the 5, 10, 15, and 20-year progression rates from chronic hepatitis to cirrhosis are 9, 23, 36, and 48% respectively [35]. Thereafter, progression of compensated to decompensated cirrhosis occurs at an annual rate of 3.2-4.6% [33]. In a Taiwanese study, the mean age at decompensation in cirrhotic patients was 57.2 years [36].…”

“…The annual rate of progression from the inactive carrier stage to HCC is 0.27-0.4%, from chronic hepatitis to HCC is 0.27-10%, Fig. 2 The clinical stages of hepatitis B [30] and from cirrhosis to HCC is 3-10% [33,37,38]. In Korea, the 5, 10, and 15-year rates of progression from chronic hepatitis to HCC is 2.7, 11, and 25% respectively, and the rate of progression from cirrhosis to HCC is 13, 27, and 42%, respectively [11].…”

Too Much of a Good Thing? When to Stop Catch-Up Vaccination

“… HBV – hepatitis B virus; ALT – alanine aminotransferase 1 Percentage of all chronically infected individuals who are aware of their infection 2 This value was estimated from 96 , and then calibrated to yield approximately 25% mortality from untreated liver disease 86, 97 . 3 Personal communication with physicians in China 4 Some therapies are discontinued if the therapy suppresses the virus. This parameter is the fraction of patients who continue on drug therapy after the therapy has suppressed the virus into a “durable response.”…”