The WHO guidelines for chronic hepatitis B fail to detect half of the patients in need of treatment in Ethiopia
The WHO guidelines for chronic hepatitis B fail to detect half of the patients in need of treatment in Ethiopia
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DOI：
10.1016/j.jhep.2019.01.037
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发表时间：
2019-06-01
影响因子：
25.7
通讯作者：
Johannessen, Asgeir
中科院分区：
文献类型：
--
作者：
Aberra, Hanna;Desalegn, Hailemichael;Johannessen, Asgeir
背景和目标：2015年，世界卫生组织（WHO）发布了低收入和中等收入国家慢性B型肝炎（CH B）管理指南，但对WHO治疗标准在撒哈拉以南非洲的适用性知之甚少。本研究的目的是评估在一个大型CHB队列在Ethiopia.Methods：治疗初治的成年人谁参加了公共CHB诊所在阿迪斯的诊断性能的世界卫生组织的指南被列入本分析。所有患者在招募时都进行了标准化评估，包括血液检查和瞬时弹性成像（Fibroscan（R））。Fibroscan结果>7.9 kPa用于定义显著纤维化，>9.9 kPa用于定义肝硬化。使用欧洲肝脏研究协会（EASL）的最新指南作为“金标准”评估治疗资格。结果：在1，190名CHB患者中，有300名（25.2%）符合EASL 2017指南的治疗资格，182名（15.3%）符合WHO 2015指南的治疗资格。WHO标准的敏感性和特异性分别为49.0%和96.1%。大多数符合WHO标准的患者（94/182; 51.6%）患有失代偿性肝硬化，即使接受治疗，预后也可能很差。115个病人中只有41个（35.7%）与代偿性肝硬化，谁是可能受益最大的治疗，有资格治疗的基础上WHO criteria.Conclusions：世界卫生组织的指南CHB未能检测到一半的患者在埃塞俄比亚需要治疗，这意味着需要修订的世界卫生组织的治疗标准。抗病毒治疗可预防慢性B型肝炎（CH B）患者的疾病进展和死亡，但在低收入和中等收入国家，识别需要治疗的患者是一项挑战。世界卫生组织（WHO）建议在这种情况下使用治疗资格标准，但在我们的研究中，WHO标准在埃塞俄比亚1，190名CHB患者的大型队列中检测到不到一半的患者需要治疗。我们的研究结果表明，世卫组织的标准可能不适合撒哈拉以南非洲地区。(C)2019年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: In 2015, the World Health Organization (WHO) issued guidelines for the management of chronic hepatitis B (CHB) in low- and middle-income countries, but little is known about the applicability of the WHO treatment criteria in sub-Saharan Africa. The aim of this study was to evaluate the diagnostic performance of the WHO guidelines in a large CHB cohort in Ethiopia.Methods: Treatment-naive adults who attended a public CHB clinic in Addis Ababa were included in this analysis. All patients underwent a standardized evaluation at recruitment, including blood tests and transient elastography (Fibroscan (R)). A Fibroscan result >7.9 kPa was used to define significant fibrosis and >9.9 kPa to define cirrhosis. Treatment eligibility was assessed using the most recent guidelines from the European Association for the Study of the Liver (EASL) as the 'gold standard'.Results: Out of 1,190 patients with CHB, 300 (25.2%) were eligible for treatment based on the EASL 2017 guidelines and 182 (15.3%) based on the WHO 2015 guidelines. The sensitivity and specificity of the WHO criteria were 49.0 and 96.1%, respectively. Most patients (94 of 182; 51.6%) who fulfilled the WHO criteria had decompensated cirrhosis and might have a dismal prognosis even with therapy. Only 41 of 115 patients (35.7%) with compensated cirrhosis, who are likely to benefit the most from therapy, were eligible for treatment based on the WHO criteria.Conclusions: The WHO guidelines for CHB failed to detect half of the patients in need of treatment in Ethiopia, implying the need for a revision of the WHO treatment criteria.Lay summary: Antiviral therapy prevents disease progression and death in patients with chronic hepatitis B (CHB), but the identification of patients in need of treatment is a challenge in low-and middle-income countries. The World Health Organization (WHO) has suggested treatment eligibility criteria for use in such settings, but in our study the WHO criteria detected less than half of those in need of therapy in a large Ethiopian cohort of 1,190 patients with CHB. Our findings suggest that the WHO criteria might be unsuitable in sub-Saharan Africa. (C) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.