title: Are non-invasive fibrosis markers for chronic hepatitis B reliable in sub-Saharan Africa?
abstract: In the absence of liver biopsy, the World Health Organization recommends non-invasive tests, such as aspartate aminotransferase to platelet ratio index and FIB-4, to assess liver fibrosis in patients with chronic hepatitis B. However, these tests are not well validated in sub-Saharan Africa. Recently, a new marker, gamma-glutamyl transpeptidase to platelet ratio, was found to be more accurate in an African setting, but this needs confirmation in other cohorts.
  
  
  
  A treatment program for chronic hepatitis B was initiated in Addis Ababa, Ethiopia, in 2015. Non-invasive tests were compared with transient elastography (Fibroscan 402, Echosense, France) using the following thresholds: no fibrosis (≤7.9 kPa), significant fibrosis (>7.9 kPa) and cirrhosis (>11.7 kPa). The diagnostic accuracy was estimated by calculating the area under the receiver operating characteristics curve.
  
  
  
  Of 582 treatment-naïve patients, 141 (24.2%) had significant fibrosis and 90 (15.5%) had cirrhosis. The area under the receiver operating characteristics curve of aspartate aminotransferase to platelet ratio index, FIB-4 and gamma-glutamyl transpeptidase to platelet ratio was high both to diagnose significant fibrosis (0.79 [95% CI 0.75-0.84], 0.79 [95% CI 0.75-0.84], 0.80 [95% CI 0.75-0.85]) and cirrhosis (0.86 [95% CI 0.81-0.91], 0.86 [95% CI 0.81-0.91], 0.87 [95% CI 0.82-0.91]). The specificity was high for all tests (94%-100%); however, the sensitivity was poor both to detect fibrosis (10%-45%) and cirrhosis (10%-36%).
  
  
  
  Aspartate aminotransferase to platelet ratio index, FIB-4 and gamma-glutamyl transpeptidase to platelet ratio had good diagnostic properties to detect liver fibrosis and cirrhosis in patients with chronic hepatitis B in East Africa. However, the sensitivity was low, and only 10% of patients with cirrhosis were detected using aspartate aminotransferase to platelet ratio index at the World Health Organization recommended threshold.
authors.affiliation: Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
authors.forename: Hailemichael
authors.initials: H
authors.lastname: Desalegn
authors.affiliation: Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
authors.forename: Hanna
authors.initials: H
authors.lastname: Aberra
authors.affiliation: Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Nega
authors.initials: N
authors.lastname: Berhe
authors.affiliation: Research Unit, Sørlandet Hospital HF, Kristiansand, Norway.|Department of Global Development and Planning, University of Agder, Kristiansand, Norway.
authors.forename: Svein G
authors.initials: SG
authors.lastname: Gundersen
authors.affiliation: Centre for Imported and Tropical Diseases, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Asgeir
authors.identifier: 0000-0001-5966-7166
authors.initials: A
authors.lastname: Johannessen
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001792:Blood Platelets; D004796:Clinical Enzyme Tests; D054459:Elasticity Imaging Techniques; D005002:Ethiopia; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human; D001219:Aspartate Aminotransferases
keywords: hepatitis B virus; liver fibrosis; non-invasive tests; sub-Saharan Africa