In the Journals

Simple HBV score accurate, applicable for decentralizing diagnosis

A diagnostic score based on hepatitis B e-antigen and alanine aminotransferase was highly accurate in selecting patients for HBV therapy, according to a recent study conducted in Africa.

Yusuke Shimakawa, MD, from the Institut Pasteur in France, and colleagues noted that the TREAT-B score’s simplicity could be useful in low- and middle-income settings with limited access to standard diagnostic tools such as liver biopsy or virus DNA testing.

“TREAT-B, a simple and inexpensive treatment eligibility score validated in African patients, may facilitate the scale up and decentralization of HBV treatment programs in sub-Saharan Africa, which may ultimately contribute towards the global HBV elimination,” Shimakawa and colleagues wrote. “Moreover, TREAT-B performed well irrespective of the age groups, HBV genotypes, the presence of obesity or cirrhosis, and better than the WHO treatment criteria.”

From December 2011 to January 2014, the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) enrolled 804 Gambian adults (64% men) positive for HBV surface antigen in the study. Most participants were asymptomatic and unaware of their infection. All participants underwent standard clinical staging.

Additionally, the researchers analyzed a validation cohort of 327 African adults from multi-international study centers.

The TREAT-B score system was calculated as follows: HBeAg score negative (0 point) or positive (1 point) added to ALT less than 20 IU/L (0 point), between 20 IU/L and 39 IU/L (1 point), between 40 IU/L and 79 IU/L (2 points) or 80 IU/L or higher (3 points), for a total of up to 4 points.

TREAT-B displayed good discrimination compared with EASL treatment criteria in both the derivation set (AUROC = 0.88) and validation set (AUROC = 0.85); compared with AASLD in derivation (AUROC = 0.89) and validation (AUROC = 0.83); and compared with APASL in derivation (AUROC = 0.87) and validation (AUROC = 0.85).

A score cut-off of 2 points had the highest sensitivity and specificity to indicate EASL (85% and 77%), AASLD (82% and 78%) and APASL (83% and 78%) treatment eligibility criteria.

Finally, the TREAT-B score had significantly higher area under receiver operating characteristic curves compared with WHO criteria in both derivation and validation sets (P < .01).

“As a public health intervention to reduce HBV-related mortality in Africa, the role of hepatitis B vaccination alone is limited because an estimated 6.1% of African adults who established chronic infection before the introduction of hepatitis B vaccines are at high risk of dying from HBV-related liver diseases in the next few decades,” the researchers wrote. “An additional population-wide ‘screen-and-treat’ may efficiently reduce these deaths, as suggested by a recent modelling study.” – by Talitha Bennett

Disclosure: Shimakawa reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

A diagnostic score based on hepatitis B e-antigen and alanine aminotransferase was highly accurate in selecting patients for HBV therapy, according to a recent study conducted in Africa.

Yusuke Shimakawa, MD, from the Institut Pasteur in France, and colleagues noted that the TREAT-B score’s simplicity could be useful in low- and middle-income settings with limited access to standard diagnostic tools such as liver biopsy or virus DNA testing.

“TREAT-B, a simple and inexpensive treatment eligibility score validated in African patients, may facilitate the scale up and decentralization of HBV treatment programs in sub-Saharan Africa, which may ultimately contribute towards the global HBV elimination,” Shimakawa and colleagues wrote. “Moreover, TREAT-B performed well irrespective of the age groups, HBV genotypes, the presence of obesity or cirrhosis, and better than the WHO treatment criteria.”

From December 2011 to January 2014, the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) enrolled 804 Gambian adults (64% men) positive for HBV surface antigen in the study. Most participants were asymptomatic and unaware of their infection. All participants underwent standard clinical staging.

Additionally, the researchers analyzed a validation cohort of 327 African adults from multi-international study centers.

The TREAT-B score system was calculated as follows: HBeAg score negative (0 point) or positive (1 point) added to ALT less than 20 IU/L (0 point), between 20 IU/L and 39 IU/L (1 point), between 40 IU/L and 79 IU/L (2 points) or 80 IU/L or higher (3 points), for a total of up to 4 points.

TREAT-B displayed good discrimination compared with EASL treatment criteria in both the derivation set (AUROC = 0.88) and validation set (AUROC = 0.85); compared with AASLD in derivation (AUROC = 0.89) and validation (AUROC = 0.83); and compared with APASL in derivation (AUROC = 0.87) and validation (AUROC = 0.85).

A score cut-off of 2 points had the highest sensitivity and specificity to indicate EASL (85% and 77%), AASLD (82% and 78%) and APASL (83% and 78%) treatment eligibility criteria.

Finally, the TREAT-B score had significantly higher area under receiver operating characteristic curves compared with WHO criteria in both derivation and validation sets (P < .01).

“As a public health intervention to reduce HBV-related mortality in Africa, the role of hepatitis B vaccination alone is limited because an estimated 6.1% of African adults who established chronic infection before the introduction of hepatitis B vaccines are at high risk of dying from HBV-related liver diseases in the next few decades,” the researchers wrote. “An additional population-wide ‘screen-and-treat’ may efficiently reduce these deaths, as suggested by a recent modelling study.” – by Talitha Bennett

Disclosure: Shimakawa reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.