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Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa
Yusuke Shimakawa'Correspondence information about the author Yusuke ShimakawaEmail the author Yusuke Shimakawa
, Ramou Njie
, Gibril Ndow
, Muriel Vray
, Papa Saliou Mbaye
, Philippe Bonnard
, Roger Sombié
, Jean Nana
, Vincent Leroy
, Julie Bottero
, Patrick Ingiliz
, Gerrit Post
, Bakary Sanneh
, Ignatius Baldeh
, Penda Suso
, Amie Ceesay
, Adam Jeng
, Harr Freeya Njai
, Shevanthi Nayagam
, Umberto D'Alessandro
, Isabelle Chemin
, Maimuna Mendy
, Mark Thursz
, Maud Lemoine'Correspondence information about the author Maud LemoineEmail the author Maud Lemoine
See Editorial, pages 765–766
Open Access
PlumX Metrics
DOI: https://doi.org/10.1016/j.jhep.2018.05.024 |
showArticle Info
Highlights
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To eliminate hepatitis B, it is essential to scale up antiviral treatment programs.
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Access to conventional tools to assess treatment eligibility is limited.
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A new diagnostic score was developed using a large dataset of African patients.
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Diagnostic accuracy of the score for selecting patients for HBV treatment was high.
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The score may facilitate scale-up of treatment programs in resource-poor countries.
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.
Keywords:
Hepatitis B, Diagnostic score, Patient care management, Validation studies, Sensitivity and specificity, Africa, Elimination |
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发表于 2018-9-15 20:28