Shimakawa, Yusuke; Njie, Ramou; Ndow, Gibril; Vray, Muriel; Mbaye, Papa Saliou; Bonnard, Philippe; Sombié, Roger; Nana, Jean; Leroy, Vincent; Bottero, Julie; +14 more... Ingiliz, Patrick; Post, Gerrit; Sanneh, Bakary; Baldeh, Ignatius; Suso, Penda; Ceesay, Amie; Jeng, Adam; Njai, Harr Freeya; Nayagam, Shevanthi; D'Alessandro, Umberto; Chemin, Isabelle; Mendy, Maimuna; Thursz, Mark; Lemoine, Maud; (2018) Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa. Journal of hepatology, 69 (4). pp. 776-784. ISSN 0168-8278 DOI: https://doi.org/10.1016/j.jhep.2018.05.024
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Abstract
BACKGROUND & AIMS: To eliminate hepatitis B virus (HBV) infection, it is essential to scale up antiviral treatment through decentralized services. However, access to the conventional tools to assess treatment eligibility (liver biopsy/Fibroscan®/HBV DNA) is limited and not affordable in resource-limited countries. We developed and validated a simple score to easily identify patients in need of HBV treatment in Africa. METHODS: As a reference, we used treatment eligibility determined by the European Association for the Study of the Liver based on alanine aminotransferase (ALT), liver histology and/or Fibroscan and HBV DNA. We derived a score indicating treatment eligibility by a stepwise logistic regression using a cohort of chronic HBV infection in The Gambia (n = 804). We subsequently validated the score in an external cohort of HBV-infected Africans from Senegal, Burkina Faso, and Europe (n = 327). RESULTS: Out of several parameters, two remained in the final model, namely HBV e antigen (HBeAg) and ALT level, constituting a simple score (treatment eligibility in Africa for the hepatitis B virus: TREAT-B). The score demonstrated a high area under the receiver operating characteristic curve (0.85, 95% CI 0.79-0.91) in the validation set. The score of 2 and above (HBeAg-positive and ALT ≥20 U/L or HBeAg-negative and ALT ≥40 U/L) had a sensitivity and specificity for treatment eligibility of 85% and 77%, respectively. The sensitivity and specificity of the World Health Organization criteria based on the aspartate aminotransferase-to-platelet ratio index (APRI) and ALT were 90% and 40%, respectively. CONCLUSIONS: A simple score based on HBeAg and ALT had a high diagnostic accuracy for the selection of patients for HBV treatment. This score could be useful in African settings. LAY SUMMARY: Limited access to the diagnostic tools used to assess treatment eligibility (liver biopsy/Fibroscan/hepatitis B virus DNA) has been an obstacle to the scale up of hepatitis B treatment programs in low- and middle-income countries. Using the data from African patients with chronic HBV infection, we developed and validated a new simple diagnostic score for treatment eligibility, which only consists of hepatitis B virus e antigen and alanine aminotransferase level. The diagnostic accuracy of the score for selecting patients for HBV treatment was high and could be useful in African settings.
Item Type | Article |
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Faculty and Department |
MRC Gambia > GM-Disease Control and Elimination Theme MRC Gambia > GM-Gambia Clinical Services/Comms |
PubMed ID | 30104154 |
ISI | 444890900008 |
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