Liver enzyme and hepatitis B 'e' antigen test results are
sufficient to determine which people with hepatitis B need antiviral treatment
for the infection in sub-Saharan Africa, a study carried out in West Africa has
shown.
The findings, published in advance online by the Journal
of Hepatology, show that expensive laboratory tests or Fibroscan
equipment are not needed to determine which people are at higher risk of
progressive liver disease and in need of treatment. Instead, blood tests
costing less than $20 identified 85% of people in need of treatment.
Treatment of hepatitis B is now feasible using generic
versions of antiviral drugs costing less than $50 a year. One of the major
barriers to treatment is determining treatment eligibility. Not everyone with
hepatitis B needs immediate treatment so, to test who is eligible,
international guidelines recommend the use of hepatitis B virus (HBV) DNA tests
to confirm viraemia and either liver biopsy or Fibroscan to test liver
fibrosis.
But DNA testing and Fibroscan are not available in many
settings. The West African study investigated whether basic laboratory tests
that could be carried out in any health facility and interpreted by all grades
of staff provided sufficient information to accurately select people in need of
treatment.
The investigators evaluated a range of laboratory
measurements and concluded that the combination of ALT levels and hepatitis B
'e' antigen predicted treatment eligibility.
The new diagnostic algorithm, called TREAT-B, was found to
accurately identify HBV-positive people who require treatment in 85% of cases
and could accurately identify those who do not need treatment in 77% of cases.
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