Clinical utility of quantifying hepatitis B surface antigen in African patients with chronic hepatitis B.
Africa
chronic hepatitis B
hepatitis B surface antigens
selection for treatment
serologic Tests
Journal
Journal of viral hepatitis
ISSN: 1365-2893
Titre abrégé: J Viral Hepat
Pays: England
ID NLM: 9435672
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
17
02
2021
accepted:
11
03
2021
pubmed:
23
3
2021
medline:
2
10
2021
entrez:
22
3
2021
Statut:
ppublish
Résumé
The clinical utility of quantifying hepatitis B surface antigen (qHBsAg) levels in African subjects with chronic hepatitis B virus (HBV) infection has been poorly documented. From a multicentre cohort of 944 HBV-infected African patients, we aimed to assess whether qHBsAg alone can accurately identify i) those in a HBeAg-negative chronic HBV infection phase at low risk of liver disease progression and ii) those in need of antiviral therapy according to the 2017 EASL guidelines. We analysed 770 HBV mono-infected treatment-naïve patients, mainly males (61%) from West Africa (92%), median age 35 years (IQR: 30-44), median HBV DNA: 95.6 IU/ml (10.0-1,300.0), median qHBsAg 5,498 IU/ml (1,171-13,000) and HBeAg-pos 38 (5%). A total of 464/770 (60.2%) patients were classified as HBeAg-negative chronic infection (median age 36 years (31-46), median ALT 23 IU/l (18-28), median HBV-DNA 33.5 IU/ml (3.8-154.1), median LSM 4.8 kPa (4.1-5.8)) and qHBsAg levels had poor accuracy to identify these subjects with an AUROC at 0.58 (95%CI: 0.54-0.62), sensitivity 55.0% and specificity 55.6%; 118/770 (15.3%) patients were eligible for treatment according to the 2017 EASL criteria. qHBsAg correlated poorly with HBV DNA and had poor accuracy to select patients for antiviral therapy with an AUROC at 0.54 (0.49-0.60), sensitivity 46.6% and specificity 46.9%. In African treatment-naïve HBV-infected subjects, the clinical utility of qHBsAg to identify subjects in HBeAg-negative infection phase or subjects eligible for antiviral therapy seems futile. Whether qHBsAg levels can be used as a predictor of long-term liver complications in Africa needs to be further investigated.
Substances chimiques
DNA, Viral
0
Hepatitis B Surface Antigens
0
Hepatitis B e Antigens
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1003-1010Subventions
Organisme : Medical Research Council
ID : MR/R011117/1
Pays : United Kingdom
Organisme : European Commission
Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
WHO. 2017 http://apps.WHO.int/iris/bitstream/10665/255016/1/9789241565455-eng.pdf?ua=1
Polaris OC. Global prevalence, treatment, and prevention of hepatitis B virus infection in 2016: a modelling study. Lancet Gastroenterol Hepatol. 2018;3(6):383-403.
.European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-398.
WHO. Guidelines for the Prevention, Care and Treatment of Persons with chronic Hepatitis B infection. 2020. http://whoint/hiv/pub/hepatitis/hepatitis-b-guidelines/en/ Last accessed June 2020.
Desalegn H, Aberra H, Berhe N, Gundersen SG, Johannessen A. Are non-invasive fibrosis markers for chronic hepatitis B reliable in sub-Saharan Africa? Liver Int. 2017;37(10):1461-1467.
Lemoine M, Shimakawa Y, Nayagam S, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut. 2016;65(8):1369-1376.
Abravanel F, Lhomme S, Tremeaux P, et al. Performance of the Xpert HBV Viral Load assay versus the Aptima Quant assay for quantifying hepatitis B virus DNA. Diagn Microbiol Infect Dis. 2020;96(2):114946.
Shimakawa Y, Ndow G, Njie R, et al. Hepatitis B core-related antigen: an alternative to hepatitis B virus DNA to assess treatment eligibility in Africa. Clin Infect Dis. 2020;70(7):1442-1452.
Fattovich G. Natural history of hepatitis B. J Hepatol. 2003;39(Suppl 1):S50-S58.
Lemoine M, Shimakawa Y, Njie R, et al. Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study. Lancet Glob Health. 2016;4(8):e559-e567.
Liaw YF. Clinical utility of hepatitis B surface antigen quantitation in patients with chronic hepatitis B: a review. Hepatology. 2011;54(2):E1-9.
Cornberg M, Wong VW, Locarnini S, Brunetto M, Janssen HLA, Chan HL. The role of quantitative hepatitis B surface antigen revisited. J Hepatol. 2017;66(2):398-411.
Chevaliez S, Hezode C, Bahrami S, Grare M, Pawlotsky JM. Long-term hepatitis B surface antigen (HBsAg) kinetics during nucleoside/nucleotide analogue therapy: finite treatment duration unlikely. J Hepatol. 2013;58(4):676-683.
Brunetto MR, Oliveri F, Colombatto P, et al. Hepatitis B surface antigen serum levels help to distinguish active from inactive hepatitis B virus genotype D carriers. Gastroenterology. 2010;139(2):483-490.
Jaroszewicz J, Calle Serrano B, Wursthorn K, et al. Hepatitis B surface antigen (HBsAg) levels in the natural history of hepatitis B virus (HBV)-infection: a European perspective. J Hepatol. 2010;52(4):514-522.
Liu J, Yang HI, Lee MH, et al. Serum Levels of Hepatitis B Surface Antigen and DNA Can Predict Inactive Carriers With Low Risk of Disease Progression. Hepatology. 2016;64(2):381-389.
Tseng TC, Liu CJ, Yang HC, et al. High levels of hepatitis B surface antigen increase risk of hepatocellular carcinoma in patients with low HBV load. Gastroenterol. 2012;142(5):1140-1149.e3.
Chan HL, Wong VW, Chim AM, Chan HY, Wong GL, Sung JJ. Serum HBsAg quantification to predict response to peginterferon therapy of e antigen positive chronic hepatitis B. Aliment Pharmacol Ther. 2010;32(11-12):1323-1331.
Nguyen T, Thompson AJ, Bowden S, et al. Hepatitis B surface antigen levels during the natural history of chronic hepatitis B: a perspective on Asia. J Hepatol. 2010;52(4):508-513.
Maylin S, Sire JM, Mbaye PS, et al. Short-term spontaneous fluctuations of HBV DNA levels in a Senegalese population with chronic hepatitis B. BMC Infect Dis. 2015;15:154.
Chakrabarty G, Bruce M, Horner M, Wang B, Agarwal K, Carey I. Can quantitative hepatitis B surface antigen levels predict the severity of liver disease in genotype E Patients? J Viral Hepat. 2018;25(1):80-87.
Ghosh S, Sow A, Guillot C, et al. Implementation of an in-house quantitative real-time polymerase chain reaction method for Hepatitis B virus quantification in West African countries. J Viral Hepat. 2016;23(11):897-904.
Chan HL, Thompson A, Martinot-Peignoux M, et al. Hepatitis B surface antigen quantification: why and how to use it in 2011 - a core group report. J Hepatol. 2011;55(5):1121-1131.
Boursier J, Zarski JP, de Ledinghen V, et al. Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2013;57(3):1182-1191.
The PROLIFICA reserach group. wwwprolifica.africa
Thompson AJ, Nguyen T, Iser D, et al. Serum hepatitis B surface antigen and hepatitis B e antigen titers: disease phase influences correlation with viral load and intrahepatic hepatitis B virus markers. Hepatology. 2010;51(6):1933-1944.
Lin LY, Wong VW, Zhou HJ, et al. Relationship between serum hepatitis B virus DNA and surface antigen with covalently closed circular DNA in HBeAg-negative patients. J Med Virol. 2010;82(9):1494-1500.
Volz T, Lutgehetmann M, Wachtler P, et al. Impaired intrahepatic hepatitis B virus productivity contributes to low viremia in most HBeAg-negative patients. Gastroenterology. 2007;133(3):843-852.
Yang N, Feng J, Zhou T, et al. Relationship between serum quantitative HBsAg and HBV DNA levels in chronic hepatitis B patients. J Med Virol. 2018;90(7):1240-1245.
Martinot-Peignoux M, Lapalus M, Asselah T, Marcellin P. The role of HBsAg quantification for monitoring natural history and treatment outcome. Liver Int. 2013;33(Suppl 1):125-132.
Lapalus M, Laouenan C, Cardoso AC, et al. Precore/Core promoter variants to predict significant fibrosis in both HBeAg positive and negative chronic hepatitis B. Liver Int. 2015;35(9):2082-2089.