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Ramírez Mena A, Thiam M, Ka D, Niang I, Tine J, Fortes L, Ndiaye K, Ndiaye O, Fall M, Gaye A, Ngom NF, Fall F, Berzigotti A, Kirk GD, Jaquet A, Seydi M, Wandeler G. Hepatocellular carcinoma surveillance among people living with hepatitis B in Senegal (SEN-B): insights from a prospective cohort study. Lancet Gastroenterol Hepatol 2024; 9:539-549. [PMID: 38588691 DOI: 10.1016/s2468-1253(24)00040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Chronic hepatitis B virus (HBV) infection is the predominant cause of hepatocellular carcinoma in west Africa, yet data on the incidence of HBV-related hepatocellular carcinoma remain scarce. We aimed to describe the uptake and early outcomes of systematic ultrasound-based hepatocellular carcinoma screening in SEN-B, which is a prospective HBV cohort in Senegal. METHODS In this prospective cohort study, we included treatment-naive, HBsAg-positive individuals who were referred to the two 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. All participants resided within the Dakar region. Participants underwent abdominal ultrasound, transient elastography, and clinical and virological assessments at inclusion and every 6 months. Liver lesions at least 1 cm in diameter on ultrasound were assessed using four-phase CT, MRI, or liver biopsy. Adherence to hepatocellular carcinoma surveillance was measured using the proportion of time covered, calculated by dividing the cumulative months covered by abdominal ultrasound examinations by the overall follow-up time, defined as the number of months from the date of cohort entry until the last recorded visit, hepatocellular carcinoma diagnosis, or death. Optimal adherence was defined as a proportion of time covered of 100%. FINDINGS Overall, 755 (99·6%) of 758 participants had at least one abdominal ultrasound performed. The median age of the enrolled participants was 31 years (IQR 25-39), 355 (47·0%) of 755 participants were women, and 82 (10·9%) had a family history of hepatocellular carcinoma. 15 (2·0%) of 755 individuals were HBeAg positive, 206 (27·3%) of 755 individuals had HBV DNA of more than 2000 IU/mL, and 27 (3·6%) of 755 had elastography-defined liver cirrhosis. Of ten (1·3%) participants with a focal lesion at least 1 cm at initial assessment, CT or MRI ruled out hepatocellular carcinoma in nine, whereas imaging and subsequent liver biopsy confirmed one patient with hepatocellular carcinoma. Two further patients with hepatocellular carcinoma were diagnosed at study presentation due to the presence of portal thrombosis on ultrasound. Excluding the three participants with hepatocellular carcinoma identified at baseline, 752 participants were eligible for screening every 6 months. Median follow-up time was 12 months (IQR 6-18) and the median number of ultrasounds per patient was 3 (2-4). During 809·5 person-years of follow-up, one incident hepatocellular carcinoma was reported, resulting in an incidence rate of 1·24 cases per 1000 person-years (95% CI 0·18-8·80). Overall, 702 (93·0%) of 755 participants showed optimal hepatocellular carcinoma surveillance, but this proportion decreased to 77·8% (42 of 54 participants) after 24 months. INTERPRETATION Hepatocellular carcinoma screening is feasible in HBV research cohorts in west Africa, but its longer-term acceptability needs to be evaluated. Long-term hepatocellular carcinoma incidence data are crucial for shaping tailored screening recommendations. FUNDING Swiss National Science Foundation, the Swiss Cancer Research Foundation, the National Cancer Institute, and Roche Diagnostics. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Adrià Ramírez Mena
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Bern, Switzerland; Service de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, Senegal.
| | - Mbaye Thiam
- Department of Radiology, Fann University Hospital, Dakar, Senegal
| | - Daye Ka
- Service de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, Senegal
| | - Ibrahima Niang
- Department of Radiology, Fann University Hospital, Dakar, Senegal
| | - Judicaël Tine
- Service de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, Senegal
| | - Louise Fortes
- Infectious Diseases Department, Dalal Jamm Hospital, Guediawaye, Senegal
| | - Kiné Ndiaye
- Centre de Traitement Ambulatoire, Fann University Hospital, Dakar, Senegal
| | - Ousseynou Ndiaye
- Centre Régional de Recherche et Formation Clinique à la Prise en Charge de Fann, Fann University Hospital, Dakar, Senegal
| | - Maguette Fall
- Service de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, Senegal
| | - Assietou Gaye
- Department of Radiology, Fann University Hospital, Dakar, Senegal
| | - Ndeye Fatou Ngom
- Centre de Traitement Ambulatoire, Fann University Hospital, Dakar, Senegal
| | - Fatou Fall
- Department of Gastroenterology and Hepatology, Hôpital Principal de Dakar, Dakar, Senegal
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregory Dale Kirk
- Johns Hopkins University, Schools of Public Health and Medicine, Baltimore, MD, USA
| | - Antoine Jaquet
- University of Bordeaux, National Institute for Health and Medical Research UMR 1219, Research Institute for Sustainable Development EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Moussa Seydi
- Service de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, Senegal
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Service de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, Senegal
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Vo-Quang E, Lemoine M. Global elimination of HBV: Is it really achievable? J Viral Hepat 2024. [PMID: 38797984 DOI: 10.1111/jvh.13955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
Hepatitis B virus (HBV) infection is a major cause of premature death worldwide. In 2016, the World Health Organization (WHO) called for HBV elimination and set up very ambitious elimination targets. The development of effective vaccines, accurate diagnostic tools and safe antiviral drugs make HBV elimination a realistic goal. However, the most constrained-resource regions, which bear the highest burden of HBV, are facing major challenges in implementing strategies to reduce HBV incidence and mortality. Developing simplified approaches adapted to resource-limited settings and scaling up interventions for the prevention and control of HBV globally are urgently needed. Whether HBV elimination will be achieved in an equitable manner and in a reasonable timeframe remains highly uncertain.
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Affiliation(s)
- Erwan Vo-Quang
- Disease Control & Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Team "Viruses, Hepatology, Cancer", Institut Mondor de Recherche Biomédicale, INSERM U955, Université Paris-Est, Créteil, France
| | - Maud Lemoine
- Team "Viruses, Hepatology, Cancer", Institut Mondor de Recherche Biomédicale, INSERM U955, Université Paris-Est, Créteil, France
- Department of Metabolism, Digestion and Reproduction, Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
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Tian J, Meng J, Yang Z, Song L, Jiang X, Zou J. Hepatitis B-related hepatocellular carcinoma: classification and prognostic model based on programmed cell death genes. Front Immunol 2024; 15:1411161. [PMID: 38799437 PMCID: PMC11116790 DOI: 10.3389/fimmu.2024.1411161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Instruction Hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC). Programmed cell death (PCD) is a critical process in suppressing tumor growth, and alterations in PCD-related genes may contribute to the progression of HBV-HCC. This study aims to develop a prognostic model that incorporates genomic and clinical information based on PCD-related genes, providing novel insights into the molecular heterogeneity of HBV-HCC through bioinformatics analysis and experimental validation. Methods In this study, we analyzed 139 HBV-HCC samples from The Cancer Genome Atlas (TCGA) and validated them with 30 samples from the Gene Expression Omnibus (GEO) database. Various bioinformatics tools, including differential expression analysis, gene set variation analysis, and machine learning algorithms were used for comprehensive analysis of RNA sequencing data from HBV-HCC patients. Furthermore, among the PCD-related genes, we ultimately chose DLAT for further research on tissue chips and patient cohorts. Besides, immunohistochemistry, qRT-PCR and Western blot analysis were conducted. Results The cluster analysis identified three distinct subgroups of HBV-HCC patients. Among them, Cluster 2 demonstrated significant activation in DNA replication-related pathways and tumor-related processes. Analysis of copy number variations (CNVs) of PCD-related genes also revealed distinct patterns in the three subgroups, which may be associated with differences in pathway activation and survival outcomes. DLAT in tumor tissues of HBV-HCC patients is upregulated. Discussion Based on the PCD-related genes, we developed a prognostic model that incorporates genomic and clinical information and provided novel insights into the molecular heterogeneity of HBV-HCC. In our study, we emphasized the significance of PCD-related genes, particularly DLAT, which was examined in vitro to explore its potential clinical implications.
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Affiliation(s)
| | | | | | | | - Xinyi Jiang
- Department of Clinical Laboratory, Wuxi People’s Hospital Affiliated Nanjing Medical University, Wuxi, China
| | - Jian Zou
- Department of Clinical Laboratory, Wuxi People’s Hospital Affiliated Nanjing Medical University, Wuxi, China
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Lebbie W, Allan-Blitz LT, Nyama ET, Swaray M, Lavalie D, Mhango M, Patiño Rodriguez M, Gupta N, Bitwayiki R. Barriers to longitudinal follow-up for hepatitis B treatment in rural Sierra Leone: A mixed methods study of retention in care. Clin Liver Dis (Hoboken) 2024; 23:e0225. [PMID: 38831767 PMCID: PMC11146505 DOI: 10.1097/cld.0000000000000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/03/2024] [Indexed: 06/05/2024] Open
Abstract
HBV disproportionately affects resource-limited settings, and retaining patients in longitudinal care remains challenging. We conducted a mixed methods investigation to understand the causes of losses to follow-up within an HBV clinic in rural Sierra Leone. We developed a multivariable logistic regression model of baseline clinical and sociodemographic factors predicting losses to follow-up, defined as failing to present for a follow-up visit within 14 months of enrollment. We included patients enrolled between April 30, 2019 and March 1, 2020, permitting 14 months of follow-up by April 30, 2021. We then developed a survey to solicit patient perspectives on the challenges surrounding retention. We interviewed randomly selected patients absent from HBV care for at least 6 months. Among 271 patients enrolled in the Kono HBV clinic, 176 (64.9%) did not have a follow-up visit within 14 months of the study end point. Incomplete baseline workup (aOR 2.9; 95% CI: 1.6-4.8), lack of treatment at baseline (aOR 5.0; 95% CI: 1.7-14.4), and having cirrhosis at baseline (aOR 3.3; 95% CI: 0.99-10.8) were independently associated with being lost to follow-up. For the patient survey, 21 patients completed the interview (median age 34 years [IQR: 25-38]). Travel-related factors were the most frequently reported barrier to retention (57%). Almost 30% suggested improved customer care might support retention in care; 24% requested to be given medication. In our setting, factors that might reduce losses to follow-up included expanded criteria for treatment initiation, overcoming transportation barriers, reducing wait times, ensuring against stockouts, and scaling up point-of-care testing services.
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Affiliation(s)
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | - Mohamed Swaray
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| | - Daniel Lavalie
- Ministry of Health and Sanitation, Freetown, Sierra Leone, Britannica, WA
| | - Michael Mhango
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
| | | | - Neil Gupta
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Remy Bitwayiki
- Partners In Health, Freetown, Sierra Leone, Britannica, WA
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Sonderup MW, Spearman CW. HBV elimination in Africa-Current status and challenges. Clin Liver Dis (Hoboken) 2024; 23:e0166. [PMID: 38707243 PMCID: PMC11068139 DOI: 10.1097/cld.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/15/2024] [Indexed: 05/07/2024] Open
Abstract
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Liu B, Liu J, Mei X, Zhang ZQ, Fang J, Zhou LL, Zheng JL, Lin HY, Zhu XL, Li DL. Pretreatment Non-Invasive Biomarkers as Predictors to Estimate Portal Vein Tumor Thrombosis (PVTT) Risk and Long-Term Survival in HBV-Related Hepatocellular Carcinoma Patients Without PVTT. J Hepatocell Carcinoma 2023; 10:2367-2382. [PMID: 38164511 PMCID: PMC10758161 DOI: 10.2147/jhc.s442487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Background PVTT is a hallmark of advanced hepatocellular carcinoma (HCC). We aim to explore the influence of non-invasive biomarkers on the occurrence of PVTT and develop and validate models for predicting prognosis in HBV-related HCC patients without PVTT. Methods A total of 1026 HBV-related HCC patients without PVTT were enrolled, with 515 in the training cohort, 216 in the internal validation cohort, and 295 in the external validation cohort. We conducted Cox regression analyses to discern the independent risk factors associated with PVTT events, PFS, and OS, then constructed and validated predictive models. The predictive and discriminatory capabilities of models were assessed using the calibration, time-dependent ROC, and DCA curves. Results In our study, 136 patients (13.3%) experienced PVTT events during the follow-up period. The Cox regression analysis unveiled that male gender, AAPR ≤0.49, APRI >0.48, extrahepatic metastasis, and multiple tumors were independent risk factors for PVTT. In the training cohort, non-invasive biomarkers (AAR and APRI), AFP, ascites, and tumor-related characteristics (extrahepatic metastasis, tumor diameter, tumor number, and PVTT event) were independent risk factors for both OS and PFS, whereas age and ALBI grade independently correlated with OS. The C-indexes of OS and PFS nomogram models were 0.795 and 0.733 in the training cohort, 0.765 and 0.716 in the internal validation cohort, and 0.780 and 0.722 in the external validation cohort, respectively. Our models demonstrated strong predictive and discriminative abilities in all cohorts and yielded a greater net benefit compared to three traditional staging systems. Conclusion Non-invasive biomarkers are expected to be reliable predictors for assessing PVTT risk and predicting prognosis among HBV-related HCC patients without PVTT.
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Affiliation(s)
- Bang Liu
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, People’s Republic of China
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
| | - Jia Liu
- Department of Hepatobiliary Surgery, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, People’s Republic of China
| | - Xuan Mei
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, People’s Republic of China
| | - Zhi-Qiang Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, People’s Republic of China
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
| | - Jian Fang
- Department of Hepatobiliary Medicine, The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, 350108, People’s Republic of China
| | - Li-Li Zhou
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
| | - Jiao-Long Zheng
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
| | - Hai-Yan Lin
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
| | - Xiu-Ling Zhu
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
| | - Dong-Liang Li
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350025, People’s Republic of China
- Department of Hepatobiliary Disease, 900TH Hospital of Joint Logistics Support Force, Fuzhou, 350025, People’s Republic of China
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Spearman CW. The burden of chronic liver disease in west Africa: a time for action. Lancet Glob Health 2023; 11:e1319-e1320. [PMID: 37517419 DOI: 10.1016/s2214-109x(23)00345-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Catherine Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa.
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