Prevalence of cirrhosis in individuals with hepatitis B virus infection in sub-Saharan Africa: Systematic review and meta-analysis.

Abstract

BACKGROUND & AIMS

Chronic hepatitis B virus (HBV) infection accounts for 30-50% of cirrhosis related deaths in sub-Saharan Africa (SSA). Since HBV-related liver cirrhosis is an indication for immediate antiviral therapy and cancer surveillance, we aimed to estimate the prevalence of liver cirrhosis among treatment-naïve patients with chronic HBV infection in SSA.

METHODS

We performed a systematic review of published articles which evaluated liver fibrosis stage among treatment-naïve HBV-infected individuals who presented to care in SSA. Our primary outcome was the prevalence of liver cirrhosis in HBsAg-positive persons, which we estimated using random-effects meta-analysis. Risk factors for liver cirrhosis were explored using subgroup-analyses and multivariable meta-regression.

RESULTS

Of 2'129 articles identified, 17 met our eligibility criteria. The studies described 22 cohorts from 13 countries, including 13 cohorts (3'204 patients) with chronic HBV mono-infection and 9 cohorts (688 patients) with HIV/HBV-coinfection. Liver fibrosis was assessed using transient elastography (10 cohorts), APRI score (11 cohorts), and Fibrotest (one cohort). The pooled prevalence of liver cirrhosis was 4.1% (95% CI 2.6-6.4) among studies from primary care facilities or general population screening, compared to 12.7% (95% CI 8.6-18.3) in studies performed in referral or tertiary care facilities (adjusted odds ratio 0.29, 95% CI 0.15-0.56). We found no association between liver cirrhosis and age, sex, test used, or HIV-coinfection.

CONCLUSIONS

Depending on the setting, between 4% and 13% of HBV-infected individuals in SSA have liver cirrhosis and need immediate antiviral therapy. These estimates should be considered for HBV treatment strategies and resource allocation.