Clinical utility of quantifying hepatitis B surface antigen in African patients with chronic hepatitis B
Gerrit Post
Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
Center for Infectiology, Berlin, Germany
Search for more papers by this authorJess Howell
Disease Elimination, Burnet Institute, Department of Gastroenterology, St. Vincent's Hospital, Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia
Search for more papers by this authorAmina Sow
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorGibril Ndow
Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
Search for more papers by this authorIsabelle Chemin
INSERM U1052, CNRS 5286, Univ Lyon, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
Search for more papers by this authorGora Lo
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorAmie Cessay
Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
Search for more papers by this authorDamien Cohen
INSERM U1052, CNRS 5286, Univ Lyon, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
Search for more papers by this authorRamou Njie
International Agency for Research on Cancer (IARC, Lyon, France
Search for more papers by this authorSouleymane Toure
Unite de Formation et de Recherche (UFR) des sciences de la santé de l’Universite de Thies, Senegal
Search for more papers by this authorMadoky Diop
Unite de Formation et de Recherche (UFR) des sciences de la santé de l’Universite de Thies, Senegal
Search for more papers by this authorRoger Sombie
Service d’hépatogastro-entérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
Search for more papers by this authorJean Nana
Department of Hepatology & Gastroenterology, Université Grenoble Alpes, Grenoble, France
Search for more papers by this authorVincent Leroy
Department of Hepatology & Gastroenterology, Université Grenoble Alpes, Grenoble, France
Search for more papers by this authorKarine Lacombe
Department of infectious diseases and tropical medicine, hôpital Saint-Antoine, SorbonneUniversité, Inserm IPLESP, APHP, Sorbonne, France
Search for more papers by this authorLamin Bojang
Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
Search for more papers by this authorFrank Tacke
Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
Search for more papers by this authorCoumba Toure-Kane
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorMourtalla Ka
Unite de Formation et de Recherche (UFR) des sciences de la santé de l’Universite de Thies, Senegal
Search for more papers by this authorMaimuna Mendy
International Agency for Research on Cancer (IARC, Lyon, France
Search for more papers by this authorSouleymane Mboup
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorMark Thursz
Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology Section, Imperial College London, St Mary’s campus, London, UK
Search for more papers by this authorYusuke Shimakawa
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
Search for more papers by this authorPatrick Ingiliz
Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
Center for Infectiology, Berlin, Germany
Search for more papers by this authorCorresponding Author
Maud Lemoine
Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology Section, Imperial College London, St Mary’s campus, London, UK
Correspondence
Maud Lemoine, Imperial College London, Department of Metabolism, Digestion and Reproduction, Hepatology section, St Mary’s hospital, South Wharf Street, London, UK.
Email: [email protected]
Search for more papers by this authorGerrit Post
Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
Center for Infectiology, Berlin, Germany
Search for more papers by this authorJess Howell
Disease Elimination, Burnet Institute, Department of Gastroenterology, St. Vincent's Hospital, Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia
Search for more papers by this authorAmina Sow
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorGibril Ndow
Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
Search for more papers by this authorIsabelle Chemin
INSERM U1052, CNRS 5286, Univ Lyon, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
Search for more papers by this authorGora Lo
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorAmie Cessay
Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
Search for more papers by this authorDamien Cohen
INSERM U1052, CNRS 5286, Univ Lyon, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Université Claude Bernard Lyon 1, Lyon, France
Search for more papers by this authorRamou Njie
International Agency for Research on Cancer (IARC, Lyon, France
Search for more papers by this authorSouleymane Toure
Unite de Formation et de Recherche (UFR) des sciences de la santé de l’Universite de Thies, Senegal
Search for more papers by this authorMadoky Diop
Unite de Formation et de Recherche (UFR) des sciences de la santé de l’Universite de Thies, Senegal
Search for more papers by this authorRoger Sombie
Service d’hépatogastro-entérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
Search for more papers by this authorJean Nana
Department of Hepatology & Gastroenterology, Université Grenoble Alpes, Grenoble, France
Search for more papers by this authorVincent Leroy
Department of Hepatology & Gastroenterology, Université Grenoble Alpes, Grenoble, France
Search for more papers by this authorKarine Lacombe
Department of infectious diseases and tropical medicine, hôpital Saint-Antoine, SorbonneUniversité, Inserm IPLESP, APHP, Sorbonne, France
Search for more papers by this authorLamin Bojang
Medical Research Council the Gambia unit (MRCG, London School of Hygiene and Tropical Medicine, Viral hepatitis Unit, Fajara, The Gambia
Search for more papers by this authorFrank Tacke
Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
Search for more papers by this authorCoumba Toure-Kane
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorMourtalla Ka
Unite de Formation et de Recherche (UFR) des sciences de la santé de l’Universite de Thies, Senegal
Search for more papers by this authorMaimuna Mendy
International Agency for Research on Cancer (IARC, Lyon, France
Search for more papers by this authorSouleymane Mboup
Laboratoire de Bactériologie & Virologie, CHNU Dalal Jamm Guediawaye, IRESSEF Diamnoadio Dakar, Senegal
Search for more papers by this authorMark Thursz
Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology Section, Imperial College London, St Mary’s campus, London, UK
Search for more papers by this authorYusuke Shimakawa
Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
Search for more papers by this authorPatrick Ingiliz
Department of Gastroenterology and Hepatology, Charité University Medical Center, Berlin, Germany
Center for Infectiology, Berlin, Germany
Search for more papers by this authorCorresponding Author
Maud Lemoine
Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, Hepatology Section, Imperial College London, St Mary’s campus, London, UK
Correspondence
Maud Lemoine, Imperial College London, Department of Metabolism, Digestion and Reproduction, Hepatology section, St Mary’s hospital, South Wharf Street, London, UK.
Email: [email protected]
Search for more papers by this authorFunding information
The PROLIFICA project (www.prolifica.africa) was funded was the EC FP7 (2011-2016) and is currently funded by the MRC UK and received support from Gilead US company. The authors thank Echosens, France, for their support; they are also grateful to all the patients and their families.
Abstract
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.
CONFLICTS OF INTEREST
ML, PI, YS and MT received research funding from Gilead US.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
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