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

Abstract

Background Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited. Methods We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization’s 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis. Results 163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1–85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9–63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] were independent predictors of cirrhosis. Conclusion Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.

Chronic hepatitis B virus infection in Eastern Ethiopia: Clinical characteristics and determinants of cirrhosis

“…Most patients in our CHB cohort were diagnosed in the inactive carrier phase, consistent with the findings of other studies from sub-Saharan Africa[ 35 - 38 ]. Based on studies from Asia, up to 20% of patients have one or more reversions to HBeAg-positive CHB (immune-reactive phase), and 20%-30% reactivate into HBeAg-negative CHB (immune-active phase)[ 10 ].…”

Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale

“…Survey questionnaire and stigma instrument development were informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical, and social aspects of the HBV epidemic in Sierra Leone 11,29–33 and the broad literature on measuring HIV‐related stigma, 34,35 which has been adapted to inform studies in understanding HBV‐related stigma 4,5 …”

“…Survey questionnaire and stigma instrument development were informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical, and social aspects of the HBV epidemic in Sierra Leone 11,[29][30][31][32][33] and the broad literature on measuring HIV-related stigma, 34,35 which has been adapted to inform studies in understanding HBV-related stigma. 4,5 The first section of the survey tool entailed a questionnaire capturing the sociodemographic characteristics and HBV-related history of the study participants, i.e., HBV status disclosure, duration since diagnosis, and having family/friends who were PWHB.…”

Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale

“…Survey questionnaire and stigma instrument development was informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical and social aspects of the HBV epidemic in Sierra Leone [11,[29][30][31][32][33] and the broad literature on measuring HIV-related stigma [34,35], which has been adapted to inform studies in understanding HBV-related stigma [4,5].…”