Management of chronic hepatitis B in Africa: is a one-stop assessment of liver disease enough? The MATCH-B study

非洲慢性乙型肝炎的管理：对肝病进行一站式评估就足够了吗？

• 批准号: MR/R011117/1
• 负责人: Maud Lemoine
• 金额: $ 112.41万
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR011117%2F1
• 关键词: Management; chronic; hepatitis; Africa; stop

Infection with hepatitis B virus (HBV) is a major public health issue worldwide with about 250 million people chronically infected. HBV is an important cause of severe liver disease including liver cancer, which has a poor prognostic. Although an effective vaccine is available to prevent HBV transmission, many people are not vaccinated in particular in Africa and get infected with a risk of serious hepatic complications. The World Health Organization (WHO) has recently recognized HBV infection as an important health threat and has called for scaling up screening and treatment interventions for hepatitis B globally in order to control HBV-related mortality by 2030 and eventually eliminate the infection. Significant progress has been made in the management of HBV-infected patients. A highly effective treatment is now available at low cost in many countries and is recommended to the most severe patients with active hepatitis. However in developing countries, which account for 80% of the HBV epidemic, interventions to fight against hepatitis B are very limited. In Africa about 80 million people are estimated to be chronically infected with HBV. Yet screening and treatment interventions and research activities to fight against hepatitis B are almost inexistent in Africa. The complexity and high cost of the current international recommendations for the management of hepatitis B represent one of the barriers to scale up HBV screening and treatment interventions in Africa. The first screen-and-treat programme for hepatitis B in Africa called PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) has been set up in 2011 in Gambia and Senegal. With the support of the Gambian and Senegalese Ministries of Health and the local communities, the programme has been very successful: almost 20,000 persons have been screened for HBV and about 2,000 infected persons have been offered clinical assessment, and 283 given antiviral treatment. PROLIFICA has also generated unique data on chronic hepatitis B in Africa, which have informed the WHO and the local Ministries of Health on the burden of hepatitis B in West Africa. The study demonstrated that the vast majority of HBV-infected adults in West Africa have inactive or mild hepatitis and do not require immediate treatment. However, whether these patients remain so without liver disease progression in mid- to long-term or do they require regular follow-up as they may develop liver complications is unknown in Africa. In addition whether HBV antiviral therapy is effective and safe to control liver complications has never been demonstrated. Within the following study, we propose to re-assess the liver disease of the 2,108 patients (untreated or treated) previously enrolled in the PROLIFICA programme. We will re-invite each patient previously enrolled in the programme in Gambia and Senegal for a comprehensive liver assessment. Infected subjects with liver disease progression will be given treatment. This study will therefore address two key unknown questions for Africa: 1/ What is the rate of liver disease progression in African patients with inactive or mild hepatitis B exposed to the African environment and can they be offered a limited monitoring? 2/ Is HBV antiviral therapy effective and safe to reduce hepatic liver complications in patients with active chronic hepatitis B in Africa? If we demonstrate that patients diagnosed to have inactive or mild hepatitis B at one single time point have no significant liver disease progression over time, it may be unnecessary to do the conventional frequent follow-up for the millions of patients with mild hepatitis B in Africa. This will save considerable amount of resources since healthcare resources are seriously limited in Africa. We believe that our study will also promote awareness on hepatitis B and its findings will eventually contribute to the development of simplified guidelines for the management of HBV infection in Africa.

丙型肝炎病毒（HBV）感染是全球一个主要的公共卫生问题，长期感染了约2.5亿人。 HBV是包括肝癌在内的严重肝病的重要原因，肝癌的预后不佳。尽管可以使用有效的疫苗来防止HBV传播，但许多人没有在非洲尤其接种疫苗，并且患有严重肝并发症的风险。世界卫生组织（WHO）最近将HBV感染视为重要的健康威胁，并呼吁在全球范围内对丙型肝炎进行筛查和治疗干预措施，以便到2030年控制与HBV相关的死亡率，并最终消除感染。在感染HBV的患者的管理中，已经取得了重大进展。现在，在许多国家 /地区，最严重的患有活性肝炎的患者建议使用高效的治疗方法。但是，在占HBV流行病的80％的发展中国家中，与乙型肝炎作斗争的干预措施非常有限。在非洲，据估计大约有8000万人感染了HBV。然而，在非洲，筛查和治疗干预措施以及与丙型肝炎作斗争的研究几乎没有。当前有关乙型肝炎管理的国际建议的复杂性和高成本代表了非洲扩大HBV筛查和治疗干预措施的障碍之一。非洲丙型肝炎的第一个筛查和治疗计划称为Prourcifica（预防非洲肝纤维化和癌症）已于2011年在冈比亚和塞内加尔制定。在冈比亚和塞内加尔卫生部和当地社区的支持下，该计划非常成功：已经对HBV进行了筛查近20,000人，并提供了大约2,000名受感染的人进行临床评估，而283人得到抗病毒治疗。多龙还产生了关于非洲慢性乙型肝炎的独特数据，该数据已将西非丙型肝炎的负担告知了世界卫生组织和当地卫生部。该研究表明，西非的绝大多数HBV感染的成年人患有不活跃或轻度肝炎，不需要立即治疗。但是，这些患者在长期至中期是否​​在没有肝病进展的情况下保持这种状态，还是需要定期随访，因为在非洲，他们可能患有肝脏并发症。此外，HBV抗病毒疗法是否有效且安全地控制肝脏并发症。在接下来的研究中，我们提议重新评估先前参加过的紫罗兰会计划的2,108例患者（未经治疗或治疗）的肝病。我们将重新识别以前在冈比亚和塞内加尔参加该计划的患者进行全面的肝脏评估。受感染的患有肝病进展的受试者将接受治疗。因此，这项研究将解决非洲的两个主要未知问题：1/暴露于非洲环境的非洲非洲患者肝病进展率是多少？是否可以提供有限的监测？ 2/ HBV抗病毒疗法有效且安全可减少非洲活跃慢性肝炎患者的肝肝脏并发症吗？如果我们证明在一个时间点被诊断出患有无活性或轻度丙型肝炎的患者随着时间的推移没有明显的肝病进展，则可能不必为非洲的数百万轻度肝炎患者进行常规频繁随访。由于非洲的医疗资源受到严重限制，这将节省大量资源。我们认为，我们的研究还将提高人们对丙型肝炎的认识，其发现最终将有助于制定非洲HBV感染管理的简化准则。

项目成果

Improving disease knowledge is critical to eliminate hepatitis B

提高疾病知识对于消除乙型肝炎至关重要

• DOI: 10.1111/jvh.13633
• 发表时间: 2021
• 期刊: Journal of Viral Hepatitis
• 影响因子: 2.5
• 作者: Lemoine M

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa.

• DOI: 10.1038/s41467-022-35729-w
• 发表时间: 2023-01-03
• 期刊: NATURE COMMUNICATIONS
• 影响因子: 16.6
• 作者: Johannessen, Asgeir;Stockdale, Alexander J.;Henrion, Marc Y. R.;Okeke, Edith;Seydi, Moussa;Wandeler, Gilles;Sonderup, Mark;Spearman, C. Wendy;Vinikoor, Michael;Sinkala, Edford;Desalegn, Hailemichael;Fall, Fatou;Riches, Nicholas;Davwar, Pantong;Duguru, Mary;Maponga, Tongai;Taljaard, Jantjie;Matthews, Philippa C.;Andersson, Monique;Mboup, Souleyman;Sombie, Roger;Shimakawa, Yusuke;Lemoine, Maud
• 通讯作者: Lemoine, Maud

Adherence to Nucleos(t)ide Analogue Therapies for Chronic Hepatitis B Infection: A Systematic Review and Meta-Analysis.

• DOI: 10.1002/hep4.1247
• 发表时间: 2018-10
• 期刊: Hepatology communications
• 影响因子: 5.1
• 作者: Ford N;Scourse R;Lemoine M;Hutin Y;Bulterys M;Shubber Z;Donchuk D;Wandeler G
• 通讯作者: Wandeler G