Study examines the scarcity of data on the incidence of HBV-related hepatocellular carcinoma in West Africa.
Hepatitis B virus molecules.
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Chronic hepatitis B virus (HBV) infection is the primary contributor to hepatocellular carcinoma (HCC) in West Africa. Screening for HCC is viable within HBV research cohorts in West Africa, yet its long-term acceptance warrants assessment. Obtaining long-term HCC incidence data is essential for informing customized screening guidelines.
755 out of 758 participants (99.6%) underwent at least 1 abdominal ultrasound. Median age was 31 years (IQR 25–39), with 355 out of 755 (47.0%) being female, and 82 out of 755 (10.9%) having a family history of HCC. 15 out of 755 (2.0%) were HBeAg positive, 206 out of 755 (27.3%) had HBV DNA levels exceeding 2000 IU/mL, and 27 out of 755 (3.6%) were diagnosed with elastography-defined liver cirrhosis. Initial assessments revealed focal lesions of at least 1 cm in 10 out of 755 participants (1.3%), with CT or MRI ruling out HCC in 9 cases and confirming 1 through subsequent liver biopsy. 2 additional cases of HCC were diagnosed during the study due to portal thrombosis observed on ultrasound. Excluding the 3 participants diagnosed with HCC at baseline, 752 participants were eligible for screening every 6 months.
“In this prospective cohort study, we included treatment-naive, HBsAg-positive individuals who were referred to the 2 infectious diseases clinics (the Department of Tropical and Infectious Diseases and Ambulatory Treatment Center) at Fann University Hospital of Dakar, Senegal, between Oct 1, 2019, and Oct 31, 2022,” according to the investigators. “All participants resided within the Dakar region.”1
The median follow-up time was 12 months (IQR 6–18), with each patient undergoing a median of 3 ultrasounds (IQR 2–4). During 809.5 person-years of follow-up, 1 incident HCC was reported, resulting in an incidence rate of 1.24 cases per 1000 person-years (95% CI 0.18–8.80). Overall, 702 out of 755 participants (93.0%) achieved optimal HCC surveillance. This proportion decreased to 77.8% (42 out of 54 participants) after 24 months.
Adherence to HCC surveillance was assessed by the proportion of time covered, which was calculated by dividing the cumulative months covered by abdominal ultrasound examinations by the overall follow-up time, defined as the duration from cohort entry to the last recorded visit, HCC diagnosis, or death. Optimal adherence was defined as achieving a proportion of time covered of 100%.
Chronic HBV infection remains a significant global health challenge, leading to approximately 1.1 million deaths in 2022, primarily from cirrhosis and hepatocellular carcinoma, according to WHO. In 2022, an estimated 254 million people worldwide were living with HBV, with the highest prevalence in the African and Western Pacific regions, where 65% of these cases are found.2
“There has not been any significant improvement in the diagnosis and treatment of HBV. The prevalence of HBV is alarming, with the disease claiming over 270,000 lives annually in Africa. The rate of diagnosis is dire; only about 3% of hepatitis cases are diagnosed, and merely 2% of those diagnosed receive treatment.”2
In conclusion, this study highlights the need for improved screening and surveillance of HBV-related HCC in West Africa. The findings underscore the importance of ongoing efforts to address the challenges posed by chronic HBV infection in the region.
