Reply to: “Validation of the TREAT-B score for hepatitis B treatment eligibility in a large Asian cohort: TREAT-B improves with age”

Shimakawa, Yusuke; Lemoine, Maud

doi:10.1016/j.jhep.2020.07.010

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Racial differences were also apparent in performance studies of the WHO simplified criteria and the TREAT-B scoring system conducted among African, European, Australian, and Vietnamese populations. The sensitivities of the WHO criteria and the TREAT-B scoring system for chronic hepatitis B treatment eligibility ranged between 53.0% and 100.0% and from 73.9% to 98.8% [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ], respectively. Similarly, the specificity ranges of the WHO criteria and TREAT-B system for chronic hepatitis B treatment eligibility were from 40% to 77.4% and 57.5% to 88.0 [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ], respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The WHO’s simplified criteria and the TREAT-B scoring system were validated in African, European, Australian, and Vietnamese populations. They showed variations in performance across geographic areas [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. The variations were explained by differences in viral genotype, modes of HBV transmission, and rates of spontaneous loss of HBeAg [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B

Geeratragool

Tangkijvanich

Nimanong

et al. 2023

Viruses

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Background: International guidelines for hepatitis B infection (HBV) recommend initiating antiviral treatment based on viral replication with inflammation or fibrosis. HBV viral loads and liver fibrosis measurements are not widely available in resource-limited countries. Aim: To develop a novel scoring system for the initiation of antiviral treatment in HBV-infected patients. Methods: We examined 602 and 420 treatment-naïve, HBV mono-infected patients for derivation and validation cohorts. We performed regression analysis to identify parameters associated with the initiation of antiviral treatment based on the European Association for the Study of the Liver (EASL) guidelines. The novel score was developed based on these parameters. Results: The novel score (HePAA) was based on HBeAg (hepatitis B e-antigen), the platelet count, alanine transaminase, and albumin. The HePAA score showed excellent performance, with AUROC values of 0.926 (95% CI, 0.901–0.950) for the derivation cohort and 0.872 (95% CI, 0.833–0.910) for the validation cohort. The optimal cutoff was ≥ 3 points (sensitivity, 84.9%; specificity, 92.6%). The HePAA score performed better than the World Health Organization (WHO) criteria and the Risk Estimation for HCC in Chronic Hepatitis B (REACH-B) score, and it performed similarly to the Treatment Eligibility in Africa for HBV (TREAT-B) score. Conclusions: The HePAA scoring system is simple and accurate for chronic hepatitis B treatment eligibility in resource-limited countries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B

Geeratragool

Tangkijvanich

Nimanong

et al. 2023

Viruses

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“…Recently, TREAT-B guideline which uses the HBV e antigen (HBeAg) status and serum ALT concentration to determine treatment eligibility for HBV treatment has been advocated (Shimakawa et al, 2018). Initially developed using individuals from The Gambia PROLIFICA project, the guideline has been evaluated in diverse populations including Europeans, Asians, Africans and Australians and has been found to have higher sensitivity and specificity compared with WHO guideline (Geeratragool et al, 2023; Howell et al, 2020; Shimakawa et al, 2019; Shimakawa & Lemoine, 2020; Vinikoor et al, 2020; Vu Hai et al, 2021). However, with the reported low specificity of the proposed guideline, the propensity for “overtreatment” could be potentially high (Luong Nguyen et al, 2024).…”

Section: Introductionmentioning

confidence: 99%

HBV and HCV prevalence and treatment eligibility assessment at a primary health facility in Ghana

Madison,

Adjei,

Agyeman

et al. 2024

Preprint

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Background: Viral hepatitis continues to be of global public health importance, especially hepatitis B and C. Hepatitis B and C account for most of the mortality and morbidity attributable to these viral infections. There is lack of accessibility to diagnostic tools, assessment for the eligibility for treatment and treatment in most LMICs, including Ghana. Assessment for HBV treatment is expensive and not widely available throughout Ghana. TREAT-B, a new, affordable and widely available assessment tool for HBV treatment eligibility, offers a cost-effective alternative to the international and local guidelines currently in use. Aim: To determine the prevalence of HBV and HCV in a cohort of patients and to assess the HBV infected for treatment eligibility. Materials and methods: A cross-sectional study of individuals diagnosed with hepatitis B infection was undertaken to assess their eligibility for treatment using local and international treatment guidelines. An additional retrospective review of records of patients screened for hepatitis B and C viruses over the period was undertaken. Questionnaires on socio-demographic were self-administered. Blood was taken for haematological analysis, liver function test, hepatitis B serological tests and DNA extraction for hepatitis B genotyping and drug sensitivity determination. Results: From the retrospective review, 3358 individuals had complete data for further analysis. Prevalence for HBV and HCV was estimated at 4.3% and 1.9% respectively. Males were 3 times more likely to be HBV positive compared to females (AOR=2.8, 95% CI: 1.8-4.2, p-value < 0.001). Those who were born after the introduction of after the UCVHB had higher odds of having HBV compared to those who were born before (AOR=3.6, 95% CI: 2.5-5.3, p-value < 0.001). Assessment of 74 HBV positive patients found, 20%, 9.5%, 4.7% and 4.7% were eligible for treatment according to the TREAT-B, the WHO simplified, Ghanaian and AASLD guidelines respectively. Conclusion: The burden of HBV and HCV infections remain high in Ghana and policies must be implemented to treat individuals eligible.

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Assessment and Simplification of Treatment Eligibility Among Patients With Chronic Hepatitis B Infection in Vietnam

Hai

Shimakawa

Kim

et al. 2020

Clinical Infectious Diseases

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Background Treatment eligibility and the accuracy of its simplified criteria have been poorly documented in patients with chronic HBV infection worldwide, especially in low-and-middle-income countries. Methods From a cohort of HBV-infected patients in Vietnam, we assessed the proportion of patients eligible for treatment using the national guidelines based on reference tests (HBV DNA quantification and FibroScan); and the accuracy of simplified treatment criteria free from HBV DNA and FibroScan (TREAT-B score and simplified WHO criteria) to select patients for antiviral therapy using the national guidelines as a reference. Results We analysed 400 consecutive treatment-naïve HBV-monoinfected patients: 49% males, median age 38 years (range: 18-86), 32% HBeAg-positive, median HBV DNA 4.8 log10 IU/ml (undetectable-8.4), median FibroScan 5.3kPa (3.0-67.8), 25% having significant liver fibrosis including 12% with cirrhosis. Of them 167 (42%) fulfilled treatment criteria according to the national guidelines. Using the national criteria as a reference, the performance of TREAT-B to select patients for treatment was high (AUROC: 0.89 (95%CI: 0.87-0.92)) with a sensitivity of 74.3% and a specificity of 88.4%. In a subset of patients with two ALT measurements over a 6-month period (n=89), the AUROC of TREAT-B was significantly higher than that of the simplified WHO criteria (p<0.001). Conclusion Our study suggests that a large proportion of patients with chronic HBV infection require antiviral therapy in Vietnam. Compared to the simplified WHO criteria free from HBV DNA quantification, TREAT-B is a better alternative to easily indicate treatment eligibility and might help scale-up treatment intervention in Vietnam.

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Reply to: “Validation of the TREAT-B score for hepatitis B treatment eligibility in a large Asian cohort: TREAT-B improves with age”

Cited by 3 publications

References 7 publications

A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B

A Novel and Simplified Score for Determining Treatment Eligibility for Patients with Chronic Hepatitis B

HBV and HCV prevalence and treatment eligibility assessment at a primary health facility in Ghana

Assessment and Simplification of Treatment Eligibility Among Patients With Chronic Hepatitis B Infection in Vietnam

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