Chronic Hepatitis B Patients in Africa Need Improved Diagnostic Tools, Study Results Show


Data are based on tests using low-cost, simple blood tests for helping decide which individuals with the disease need treatment.

Investigators are calling for a revision to the guidelines of treatment for hepatitis B in Africa, hoping to improve access to those who need it.1

In the study published in Nature Communications, investigators from the Hepatitis B in Africa Collaborative Network (HEPSANET) tested the use of low-cost, simple blood tests to help decide which individuals with hepatitis B need treatment.1

“Our findings are timely since [World Health Organization (WHO)] guidelines for hepatitis B are currently undergoing revision. A lower APRI threshold is needed, and the revised guidelines should take account of our new findings,” Alexander Stockdale, MBChB, MRes, PhD, DTM&H, MRCP (Inf Dis), a senior clinical lecturer at the University of Liverpool and Malawi-Liverpool-Wellcome Trust Clinical Research Programme, said in a statement.1

“Patients and [physicians] in Africa need simple, accessible guidelines that offer improved access to treatment now,” he said.1

Individuals from 12 sites in 8 African countries were included in the study. Investigators used sharing data from different centers that provide care for individuals with hepatitis B.1

They tested a combination of accessible and cheap blood tests and how well they could help predict increased liver stiffness, which is a marker of advanced liver disease. Individuals who have increased liver stiffness are at risk of complications, including liver failure and liver cancer, which can be prevented with timely antiviral treatment.1

Investigators found that the existing WHO guidelines from 2015, recommending a simple biomarker called APRI to assess liver injury, is not adapted for an African population. They proposed lowering the treatment decision threshold of the biomarker for African individuals, calling for guidelines that could be better adapted to an African setting.1

The global hepatitis B elimination strategy developed by the WHO has been adopted in most countries, but the African continent is still affected by hepatis B, investigators said.1

“Our study really illustrates the power in systematically pooling all available data on a given research topic and analyzing them together using robust statistical models. In our case, we have comprehensively shown that existing WHO diagnostic guidelines using the APRI biomarker are inadequate for sub-Saharan African populations,” Marc Henrion, a senior lecturer in biostatistics at the Liverpool School of Tropical Medicine and Malawi-Liverpool-Wellcome Trust Clinical Research Programme, said in the statement.1

“Further, we have estimated and evaluated improved rule-in and rule-out diagnostic thresholds for these populations,” he said.1

The HEPSANET group advocates for better care for those in Africa who are infected with hepatitis B.1

Limitations of the study included APRI GPR displayed were reduced in individuals with alcohol abuse. Additionally, there was an overall low risk of bias in the study. However, a small number of non-random selection criteria or specific exclusions from the investigators could limit the applicability.2


1. Improved diagnostic tools needed for chronic hepatitis B patients in Africa. EurekAlert. News release. January 5, 2023. Accessed January 10, 2023.

2. Johannessen A, Stockdale AJ, Henrion MYR, et al. Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa. Nat Commun. 2023;14(1):45. doi:10.1038/s41467-022-35729-w

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