Prevalence of liver cirrhosis in individuals with hepatitis B virus infection in sub‐Saharan Africa: Systematic review and meta‐analysis

Abstract

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.

Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with Hepatitis B virus infection in Freetown, Sierra Leone: a cross-sectional study

“…A systemic review and meta-analysis by Surial et al [ 29 ] reported a pooled cirrhosis prevalence of 6.1% (n = 3204) in sub-Saharan Africa, using a combination of non-invasive assessments including transient elastography, APRI score and FibroTest. The prevalence of cirrhosis in our study using the APRI and FIB-4 scores are in agreement with Surial et al [ 29 ] and with other reports from the West Africa region which have estimated the prevalence of cirrhosis among HBV mono-infected individuals as ranging from 0% (n = 26) in prisoners in the Ivory Coast [ 30 ] to 7.3% (n = 300) in blood donors in the Gambia [ 31 ].…”

Screening for hepatocellular carcinoma among adults with HIV/HBV co-infection in Zambia: a pilot study

“…Although our study population consisted mainly of young HIV/HBV-coinfected individuals on tenofovir-containing ART, a significant proportion had relevant risk factors for the development of HCC: 7% had a liver stiffness measurement consistent with liver cirrhosis and 60% had a high HBV VL at the time of ART start. The prevalence of liver cirrhosis among people with HBV in our study is in line with the results of a recent meta-analysis, which showed similar estimates across SSA, and did not find evidence of a significant difference between HIV-infected and uninfected individuals (Surial et al, 2020). Interestingly, most individuals with liver stiffness compatible with cirrhosis did not have signs of liver cirrhosis on ultrasound.…”

Prevalence and Predictors of Liver Fibrosis in People Living with Hepatitis B in Senegal

“…Although transient elastography is considered the best method for the non-invasive measurement of liver fibrosis in individuals with HBV infection, it is rarely available in African healthcare-settings. A recent meta-analysis, including both pwHBV and pwHIV/HBV, found only seven studies across Africa reporting fibrosis using TE [ 3 ]. The pooled prevalence of significant fibrosis was 11.6%, and the estimate for cirrhosis was 6.1%, both very similar to our results.…”

“…Hepatitis B virus (HBV) infection affects >10% of the general population in West Africa, and is the first cause of liver cirrhosis and cancer [ 1 , 2 ]. According to a recent meta-analysis, between 4% and 13% of people living with HBV in Africa had signs of liver cirrhosis, an indication for the immediate initiation of antiviral therapy [ 3 ]. The risk of liver-related complications in the region is further exacerbated by co-existing environmental factors, such as the exposure to aflatoxin, and co-infections with HIV, hepatitis delta or Schistosoma mansoni [ 4 , 5 , 6 ].…”