Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

Abstract

Summary Background In 2016, of the estimated 257 million people living with chronic hepatitis B virus (HBV) infection worldwide, only a small proportion was diagnosed and treated. The insufficiency of information on the proportion of people infected with HBV who are eligible for treatment limits the interpretation of global treatment coverage. We aimed to estimate the proportion of people with chronic HBV infection who were eligible for antiviral treatment worldwide, based on the WHO 2015 guidelines. Methods In this systematic review and meta-analysis, we searched Medline, EMBASE, and the Cochrane databases from Jan 1, 2007, to Jan 31, 2018, for studies describing HBsAg-positive people in the population or health-care facilities. We extracted information from published studies using a standardised form to estimate the frequency of cirrhosis, abnormal alanine aminotransferase (ALT), HBV DNA exceeding 2000 IU/mL or 20 000 IU/mL, presence of HBeAg, and eligibility for treatment as per WHO and other guidelines as reported in the studies. We pooled proportions through meta-analysis with random effects. The study was registered with PROSPERO, CRD42020132345. Findings Of the 13 497 studies, 162 were eligible and included in our analysis. These studies included 145 789 participants. The pooled estimate of the proportion of cirrhosis was 9% (95% CI 8–10), ranging from 6% (4–8) in community settings to 10% (9–11) in clinic settings. Examining the proportion of participants who had characteristics used to determine eligibility in the WHO guidelines, 1750 (10·1%) of 17 394 had HBV DNA exceeding 20 000 IU/mL, and 20 425 (30·8%) of 66 235 had ALT above the upper limit of normal. 32 studies reported eligibility for treatment according to WHO or any other guidelines, with a pooled estimate of eligibility at 19% (95% CI 18–20), ranging from 12% (6–18) for studies in community settings to 25% (19–30) in clinic settings. Interpretation Many studies described people with HBV infection, but few reported information in a way that allowed assessment of eligibility for treatment. Although about one in ten of the 257 million people with HBV infection (26 million) might be in urgent need of treatment because of cirrhosis, a larger proportion (12–25%) is eligible for treatment in accordance with different guidelines. Future studies describing people with HBV infection should report on treatment eligibility, according to broadly agreed definitions. Funding WHO and US Centers for Disease Control and Prevention.

CRISPR/Cas12-Based Ultra-Sensitive and Specific Point-of-Care Detection of HBV

“…Hepatitis B is an infectious disease caused mainly by liver lesions resulting from hepatitis B virus (HBV) infection, and is recognized as a global public health problem [ 1 , 2 ]. In 2015, the World Health Organization estimated that 257 million people worldwide have been infected with the HBV (HBsAg positive) and 887,000 died from chronic hepatitis B [ 3 , 4 ]. Approximately 68% of these infections were mainly recorded in developing countries in the medically poor western Pacific region and Africa [ 5 , 6 ].…”

Prevalence of hepatitis B e antigenemia in Bahraini hepatitis B patients: A retrospective, single‐center study

“…Almost one‐fifth of the hepatitis B patients in our study had positive HBeAg, indicating their high infectivity and high viral replication. This level is higher that the prevalence reported in other studies 12 . This is of important consideration because it reflects that the rates of transmission of infection are expected to be high, and better measures should be adapted to reduce the disease infectivity.…”

“…This level is higher that the prevalence reported in other studies. 12 This is of important consideration because it reflects that the rates of transmission of infection are expected to be high, and better measures should be adapted to reduce the disease infectivity. It also highlights a potential rise in the incidence of cirrhosis and HCC.…”

Development and clinical validation of loop-mediated isothermal amplification (LAMP) assay to diagnose high HBV DNA levels in resource-limited settings

“…In 2016, WHO adopted a global strategy to eliminate HBV as a public health threat by 2030, and increasing treatment uptake from 8% to 80% in HBV-infected people eligible for antiviral therapy has become a key intervention [2]. Since >95% of HBV-infected people live in low-income and middle-income countries (LMICs) and only 12-25% of infected people are eligible for anti-HBV therapy [3,4], it is crucial to expand diagnostic services to assess treatment eligibility in these countries.…”