估算全世界有資格接受乙型肝炎抗病毒治療的慢性乙型肝炎

StephenW

Estimating the proportion of people with chronic hepatitis B virus infection eligible for hepatitis B antiviral treatment worldwide: a systematic review and meta-analysis

    Mingjuan Tan, MD †
    Ajeet S Bhadoria, MD †
    Fuqiang Cui, PhD
    Alex Tan
    Judith Van Holten, PhD
    Philippa Easterbrook, MD
    et al.
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Open AccessPublished:November 13, 2020DOI:https://doi.org/10.1016/S2468-1253(20)30307-1
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Summary
Background
In 2016, of the estimated 257 million people living with chronic hepatitis B virus (HBV) infection worldwide, only a small proportion was diagnosed and treated. The insufficiency of information on the proportion of people infected with HBV who are eligible for treatment limits the interpretation of global treatment coverage. We aimed to estimate the proportion of people with chronic HBV infection who were eligible for antiviral treatment worldwide, based on the WHO 2015 guidelines.
Methods
In this systematic review and meta-analysis, we searched Medline, EMBASE, and the Cochrane databases from Jan 1, 2007, to Jan 31, 2018, for studies describing HBsAg-positive people in the population or health-care facilities. We extracted information from published studies using a standardised form to estimate the frequency of cirrhosis, abnormal alanine aminotransferase (ALT), HBV DNA exceeding 2000 IU/mL or 20 000 IU/mL, presence of HBeAg, and eligibility for treatment as per WHO and other guidelines as reported in the studies. We pooled proportions through meta-analysis with random effects. The study was registered with PROSPERO, CRD42020132345.
Findings
Of the 13 497 studies, 162 were eligible and included in our analysis. These studies included 145 789 participants. The pooled estimate of the proportion of cirrhosis was 9% (95% CI 8–10), ranging from 6% (4–8) in community settings to 10% (9–11) in clinic settings. Examining the proportion of participants who had characteristics used to determine eligibility in the WHO guidelines, 1750 (10·1%) of 17 394 had HBV DNA exceeding 20 000 IU/mL, and 20 425 (30·8%) of 66 235 had ALT above the upper limit of normal. 32 studies reported eligibility for treatment according to WHO or any other guidelines, with a pooled estimate of eligibility at 19% (95% CI 18–20), ranging from 12% (6–18) for studies in community settings to 25% (19–30) in clinic settings.
Interpretation
Many studies described people with HBV infection, but few reported information in a way that allowed assessment of eligibility for treatment. Although about one in ten of the 257 million people with HBV infection (26 million) might be in urgent need of treatment because of cirrhosis, a larger proportion (12–25%) is eligible for treatment in accordance with different guidelines. Future studies describing people with HBV infection should report on treatment eligibility, according to broadly agreed definitions.
Funding
WHO and US Centers for Disease Control and Prevention.

StephenW

估算全世界有資格接受乙型肝炎抗病毒治療的慢性乙型肝炎病毒感染者的比例：系統評價和薈萃分析

    譚明娟，醫學博士†
    馬里蘭州阿耶特·巴哈多里亞†
    崔福強博士
    亞歷克斯·譚
    朱迪思·範·霍爾滕（Judith Van Holten）博士
    Philippa Easterbrook，醫學博士
    等。
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開放獲取發佈時間：2020年11月13日DOI：https：//doi.org/10.1016/S2468-1253（20）30307-1
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概要
背景
2016年，全球估計有2.57億人患有慢性乙型肝炎病毒（HBV）感染，其中只有一小部分被診斷和治療。關於有資格接受治療的HBV感染者比例的信息不足，限制了對全球治療覆蓋率的解釋。根據世界衛生組織2015年指南，我們旨在估算全球有資格接受抗病毒治療的慢性HBV感染者的比例。
方法
在此系統的回顧和薈萃分析中，我們搜索了2007年1月1日至2018年1月31日期間的Medline，EMBASE和Cochrane數據庫，以研究描述人群或醫療機構中HBsAg陽性的人的研究。我們以標準化的形式從已發表的研究中提取信息，以估計肝硬化的發生頻率，異常的丙氨酸氨基轉移酶（ALT），HBV DNA超過2000 IU / mL或20 000 IU / mL，HBeAg的存在以及是否符合WHO和研究中報告的其他指南。我們通過薈萃分析匯總了具有隨機效應的比例。該研究已在PROSPERO註冊，註冊號為CRD42020132345。
發現
在13項497項研究中，有162項符合條件並納入了我們的分析。這些研究包括145 789名參與者。合併肝硬化比例的估計值為9％（95％CI 8-10），範圍從社區設置的6％（4-8）到臨床設置的10％（9-11）。檢查具有用於確定WHO指南資格的特徵的參與者比例，17 394中1750（10·1％）的HBV DNA超過20 000 IU / mL，66 235中20 425（30·8％）的HBV DNA超過20 000 IU / mL。 ALT高於正常上限。 32項研究報告了根據WHO或任何其他準則的治療資格，對合格率的綜合估計為19％（95％CI 18-20），範圍從在社區環境中進行研究的12％（6-18）到25％（ 19–30）。
解釋
許多研究描述了患有HBV感染的人，但是很少報告能夠評估治療資格的信息。儘管2.57億HBV感染者（2,600萬人）中約有十分之一因肝硬化而急需治療，但仍有較大比例的人（12–25％）有資格根據不同的指南進行治療。根據公認的定義，未來描述HBV感染者的研究應報告治療資格。
資金
世衛組織和美國疾病預防控制中心。

StephenW

https://www.thelancet.com/journa ... 20)30307-1/fulltext