Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa
File(s)
Published version
Author(s)
Type
Journal Article
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 non-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 (EASL) based on alanine transaminase (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, and constituted a simple score (TREAT-B). The score demonstrated a high area under the receiver operating characteristic (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 WHO criteria based on APRI and ALT were 90% and 40%, respectively.
Conclusions
The diagnostic accuracy of a simple score based on HBeAg and ALT for selecting patients for HBV treatment is high and could be useful in African settings.
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 non-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 (EASL) based on alanine transaminase (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, and constituted a simple score (TREAT-B). The score demonstrated a high area under the receiver operating characteristic (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 WHO criteria based on APRI and ALT were 90% and 40%, respectively.
Conclusions
The diagnostic accuracy of a simple score based on HBeAg and ALT for selecting patients for HBV treatment is high and could be useful in African settings.
Date Issued
2018-10
Date Acceptance
2018-05-02
Citation
Journal of Hepatology, 2018, 69 (4), pp.776-784
ISSN
0168-8278
Publisher
Elsevier
Start Page
776
End Page
784
Journal / Book Title
Journal of Hepatology
Volume
69
Issue
4
Copyright Statement
© 2018 European Association for the Study of the Liver. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Identifier
https://www.sciencedirect.com/science/article/pii/S0168827818321020?via%3Dihub
Subjects
Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Hepatitis B
Diagnostic score
Patient care management
Validation studies
Sensitivity and specificity
Africa
Elimination
CHRONIC HEPATITIS-B
CLINICAL-PRACTICE GUIDELINES
HEPATOCELLULAR-CARCINOMA
VIRUS INFECTION
VIRAL-HEPATITIS
NATURAL-HISTORY
SURFACE-ANTIGEN
LIVER FIBROSIS
WEST-AFRICA
RISK SCORE
Africa
Diagnostic score
Elimination
Hepatitis B
Patient care management
Sensitivity and specificity
Validation studies
1103 Clinical Sciences
Gastroenterology & Hepatology
Publication Status
Published
Date Publish Online
2018-07-01