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Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

Title: Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia
Authors: Shimakawa, Y
Lemoine, M
Njai, HF
Bottomley, C
Ndow, G
Goldin, RD
Jatta, A
Jeng-Barry, A
Wegmuller, R
Moore, SE
Baldeh, I
Taal, M
D'Alessandro, U
Whittle, H
Njie, R
Thursz, M
Mendy, M
Item Type: Journal Article
Abstract: Background The natural history of chronic HBV infection in sub-Saharan Africa is unknown. Data are required to inform WHO guidelines that are currently based on studies in Europe and Asia. Methods Between 1974 and 2008, serosurveys were repeated in two Gambian villages, and an open cohort of treatment-naive chronic HBV carriers was recruited. Participants were followed to estimate the rates of hepatitis B e (HBeAg) and surface antigen (HBsAg) clearance and incidence of hepatocellular carcinoma (HCC). In 2012–2013, a comprehensive liver assessment was conducted to estimate the prevalence of severe liver disease. Results 405 chronic carriers (95% genotype E), recruited at a median age of 10.8 years, were followed for a median length of 28.4 years. Annually, 7.4% (95% CI 6.3% to 8.8%) cleared HBeAg and 1.0% (0.8% to 1.2%) cleared HBsAg. The incidence of HCC was 55.5/100 000 carrier-years (95% CI 24.9 to 123.5). In the 2012–2013 survey (n=301), 5.5% (95% CI 3.4% to 9.0%) had significant liver fibrosis. HBV genotype A (versus E), chronic aflatoxin B1 exposure and an HBsAg-positive mother, a proxy for mother-to-infant transmission, were risk factors for liver fibrosis. A small proportion (16.0%) of chronic carriers were infected via mother-to-infant transmission; however, this population represented a large proportion (63.0%) of the cases requiring antiviral therapy. Conclusions The incidence of HCC among chronic HBV carriers in West Africa was higher than that in Europe but lower than rates in East Asia. High risk of severe liver disease among the few who are infected by their mothers underlines the importance of interrupting perinatal transmission in sub-Saharan Africa.
Issue Date: 9-Nov-2016
Date of Acceptance: 25-Jun-2015
URI: http://hdl.handle.net/10044/1/52191
DOI: https://dx.doi.org/10.1136/gutjnl-2015-309892
ISSN: 0017-5749
Publisher: BMJ Publishing Group
Start Page: 2007
End Page: 2016
Journal / Book Title: Gut
Volume: 65
Issue: 12
Copyright Statement: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Sponsor/Funder: Commission of the European Communities
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Trust
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: 265994
RDA15 79560
N/A
MR/L002086/1
RDB04 79560
RD207
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
HEPATITIS-B-VIRUS
HEPATOCELLULAR-CARCINOMA
E-ANTIGEN
INFANT VACCINATION
CLINICAL-OUTCOMES
CHRONIC CARRIERS
VIRAL LOAD
DNA
CHILDREN
EFFICACY
EPIDEMIOLOGY
HEPATITIS B
HEPATOCELLULAR CARCINOMA
Adolescent
Adult
Aged
Biomarkers
Carcinoma, Hepatocellular
Carrier State
Child
Female
Follow-Up Studies
Gambia
Hepatitis B Surface Antigens
Hepatitis B e Antigens
Hepatitis B, Chronic
Humans
Incidence
Infant
Infectious Disease Transmission, Vertical
Longitudinal Studies
Male
Middle Aged
Pregnancy
Prevalence
Risk Factors
Surveys and Questionnaires
1103 Clinical Sciences
1114 Paediatrics And Reproductive Medicine
Publication Status: Published
Appears in Collections:Division of Surgery
Department of Medicine
Faculty of Medicine



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