Towards better diagnostic tools for liver injury in low-income and middle-income countries

Moed, Saundria; Zaman, Muhammad H.

doi:10.1136/bmjgh-2019-001704

Cited by 8 publications

(10 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ultimate goal of screening and diagnosis is to link patients to treatment and management of viral infection in order to reduce severe outcomes, including cirrhosis and hepatocellular carcinoma. As there is a lack of accessible options to diagnose liver disease and injury within LMIC (117), timely diagnosis of chronic infection involving RDTs is a means to address the ongoing burden of viral hepatitis within LMIC regions.…”

Section: Utility Of Hbv and Hcv Rapid Diagnostic Tests In Lmicmentioning

confidence: 99%

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

Shenge¹,

Osiowy

2021

Front.Virol.

View full text Add to dashboard Cite

The global health challenge posed by hepatitis B virus (HBV) and hepatitis C virus (HCV) persists, especially in low-and-middle-income countries (LMICs), where underdiagnosis of these viral infections remains a barrier to the elimination target of 2030. HBV and HCV infections are responsible for most liver-related mortality worldwide. Infected individuals are often unaware of their condition and as a result, continue to transmit these viruses. Although conventional diagnostic tests exist, in LMIC they are largely inaccessible due to high costs or a lack of trained personnel, resulting in poor linkage to care and increased infections. Timely and accurate diagnosis is needed to achieve elimination of hepatitis B and C by the year 2030 as set out by the World Health Organization Global Health Sector Strategy. In this review rapid diagnostic tests allowing for quick and cost-effective screening and diagnosis of HBV and HCV, are discussed, as are their features, including suitability, reliability, and applicability in LMIC, particularly those within Africa.

show abstract

Section: Utility Of Hbv and Hcv Rapid Diagnostic Tests In Lmicmentioning

confidence: 99%

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

Shenge¹,

Osiowy

2021

Front.Virol.

View full text Add to dashboard Cite

show abstract

“…The incidence, prevalence, and mortality from liver cirrhosis increased in the last decades and had a considerable impact on health care systems [1][2][3]. Liver cirrhosis was often associated with a series of complications including esophageal varices (EVs).…”

Section: Introductionmentioning

confidence: 99%

Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography

Samy

Gamal

Othman

et al. 2022

Egypt J Radiol Nucl Med

View full text Add to dashboard Cite

Background Esophageal variceal hemorrhage (EVH) has been shown to be a leading cause of mortality in patients with portal hypertension. Our purpose was to assess the utility of multi-detector computed tomography (MDCT) features in the assessment of esophageal varices (EVs) and esophageal variceal hemorrhage (EVH). This prospective study included 85 cirrhotic patients who underwent MDCT and Upper Gastrointestinal Tract (UGIT) endoscopy within 2 weeks. Four radiologists evaluated the presence of EVs and the presence and size of different collaterals. Multivariable logistic regression analysis was calculated to investigate the significant predictors influencing EV and EVH. Results Findings of EV with MDCT were the best predictor of EV or EVH. The presence (and/or size) of following collaterals had significant association with both EV and EVH: paraesophageal (p < 0.001, < 0.001), short gastric (p = 0.024, 0.010), gastric varicosities (p < 0.001, < 0.001), coronary (p < 0.001, < 0.001), and main coronary vein (MCV) (p < 0.001, = 0.011). We proposed an imaging-based model (presence of coronary collaterals, main coronary vein size > 3.5 mm, presence of short gastric collaterals, presence of gastric varicosities, size > 1.5 mm) with 97% sensitivity, 91% specificity, and 94% accuracy to predict EVs. We suggested another model (presence of paraesophageal collaterals, presence of short gastric vein (SGC), SGC size > 2.5 mm, main coronary vein size > 3.5 mm, gastric varicosities size > 1.5 mm, size of EVs > 4 mm, and Child C score) to predict EVH with 98% sensitivity, 81% specificity, and 89.5% accuracy. Inter-observer agreement was high in the detection of EVs (W. Kappa = 0.71–0.88). Conclusion MDCT is an effective modality in the diagnosis of EVs. At MDCT, the presence and/or size of various collaterals including para-esophageal, short gastric, coronary collaterals, and gastric varicosities are accurate predictors for either EVs existence or EVH. We suggested two computed tomography imaging-based models with high reproducibility and acceptable accuracy for the prediction of EV and EVH. With cirrhotic patients, we recommend that radiologists report collaterals in their daily practice.

show abstract

“…11 However, ALT levels > 5 × ULN corresponding to Grade 3 hepatotoxicity severity suggests a serious damage to the liver and is indicative of liver disease. 10,11 ALT levels can be combined with aspartate aminotransferase (AST) measurements and platelet counts to determine the AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) scores, 12,13 which are widely used in resourcelimited settings to assess fibrosis severity and cirrhosis. 14 The high cut-off of >1.5 for APRI score and >3.25 for FIB-4 score provided by the World Health Organization are used to indicate the presence of significant cirrhosis and severe fibrosis.…”

Section: Introductionmentioning

confidence: 99%

“…While screening and diagnostic methods for liver injury from liver diseases, such as imaging and liver biopsy, may not be feasible for most PLHIV in low‐income settings, 10 a relatively inexpensive and non‐invasive screening method to manage the liver disease is to test the function of liver enzymes (transaminase). Alanine aminotransferase (ALT), found commonly in the liver, is released from damaged liver cells increasing the measure of ALT activity in the serum 11 .…”

Section: Introductionmentioning

confidence: 99%

Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia‐Pacific

Rupasinghe¹,

Choi

Yunihastuti

et al. 2022

Journal of Medical Virology

View full text Add to dashboard Cite

Liver disease is a growing burden among people living with HIV (PLHIV) in resourcelimited settings. As an indicator of liver disease, risk factors of high alanine aminotransferase (ALT) and cirrhosis were assessed among PLHIV in the TREAT Asia HIV Observational Database (TAHOD). Patients on combination antiretroviral therapy (cART) with a pre-cART ALT measurement and at least one follow-up ALT measurement were included. Factors associated with high ALT (ALT levels > 5 times its upper limit of normal) were analyzed using repeated measure logistic regression over a 10-year follow-up period. Liver cirrhosis was defined as having an AST to Platelet Ratio Index score > 1.5, fibrosis-4 score > 3.25, or a clinical diagnosis of cirrhosis. Cox regression analysis stratified by site was used to analyze factors associated with cirrhosis among those in follow-up after 2015. Of 5182 patients, 101 patients (1.9%) had high ALT levels with hepatitis C virus (HCV) antibody positive (odds ratio [OR]: 4.98, 95% confidence interval [CI]: 2.82-8.77, p < 0.001) and ever high alcohol consumption (OR: 2.33, 95% CI: 1.00-5.46, p = 0.050) as likely factors. Among 6318 PLHIV in the liver cirrhosis analysis, 151 (2%) developed cirrhosis (incidence rate = 0.82 per 100 person-years). Those HCV-antibody positive (hazard ratio [HR]: 5.54, 95% CI: 3.75-8.18, p < 0.001) and had high alcohol consumption (HR: 2.06, 95% CI: 1.23-3.45, p = 0.006) were associated with liver cirrhosis. HCV-antibody positive and high alcohol consumption are factors associated with high ALT. With raised ALT levels as a known factor associated with liver cirrhosis, greater efforts are required in managing ALT levels and reducing the risk of developing liver cirrhosis among those positive for HCV-antibody and those who consume alcohol.

show abstract

Towards better diagnostic tools for liver injury in low-income and middle-income countries

Cited by 8 publications

References 41 publications

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

Rapid Diagnostics for Hepatitis B and C Viruses in Low- and Middle-Income Countries

Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography

Factors associated with high alanine aminotransferase (ALT) and cirrhosis in people living with HIV on combination antiretroviral treatment (cART) in the Asia‐Pacific

Contact Info

Product

Resources

About