Hepatitis B: to better identify patients eligible for treatment in Africa

Des particules virales de l'hépatite B sont colorées en orange sur cette photographie en microscopie à transmission /CDC/ Dr. Erskine Palmer

Scientists at the Institut Pasteur in Paris and the Institut Pasteur in Dakar have developed a simple and effective method for identifying patients who could be treated for hepatitis B.

In 2016, WHO set up an ambitious strategy to eliminate hepatitis B. It also set a global target of 80% antiviral therapy treatment coverage by 2030.

Patients with chronic hepatitis B can be diagnosed with a simple and inexpensive test that detects HBs antigen, a marker of infection. Three indexes are currently used to select among those patients the ones who are eligible for treatment: hepatic inflammation with a biochemical test, liver fibrosis with fibroscan and viral load with PCR. In many resource-limited countries, these costly methods, in particular PCR, are an obstacle to treatment programs implementation.

In an article published in the Journal of Hepatology, researchers from the Institut Pasteur Epidemiology of Emerging Diseases Unit in partnership with the Imperial College of London and the Institut Pasteur de Dakar built up a new score that simplify the identification of patients eligible for treatment.

Using a statistical model, the researchers selected among the diagnosis markers those that were significantly associated with treatment eligibility. Two markers were identified: the Hbe antigen (viral replication marker) and the alanine amino transferase (ALT) level, a biochemical marker.

"These two markers are easily accessible in every hospital in Africa. They were validated with independent data from cohorts of patients in Gambia, Senegal, Burkina Faso and African patients living in Europe" explains Dr. Yusuke Shimakawa from the Institut Pasteur Epidemiology of Emerging Diseases Unit.

With a sensitivity of 85% and a specificity of 77%, the performance of this new method to identify patients eligible for hepatitis B treatment is higher than the one currently recommended by WHO (90% and 40% respectively).

The hepatitis B virus remains a major public health issue today. An estimated 257 million people are living with a hepatitis B virus infection worldwide.

Reference: Y. Shimakawa et al., Journal of Hepatology, 69, 776, 2018.

This paper has been written and published by the Institut Pasteur.


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