The practice of hepatocellular cancer surveillance in Nigeria

Background: Hepatocellular cancer is a disease of global and public health importance due to the widespread distribution of risk factors and associated high case fatality. Hepatocellular Cancer (HCC) in Sub-Saharan Africa is commonly seen among the younger age groups (<45 years) who present mostly in the terminal stage, when the disease is not amenable to any curative therapy. Hepatocellular Carcinoma surveillance employs the use of simple, cheap and readily available investigations, to detect early curable cancer in individuals with risk factors for HCC.Objectives:The aim of this study is to assess the practice of hepatocellular cancer screening among physicians.Methodolgy:This is a nationwide online survey carried out among physicians who care for patients with HCC. A questionnaire was sent out via a web link to all consenting doctors in Nigeria. The responses were collated in a cloud-based application and data was analysed using Epi-info version 20.Results:Atotal of 218 respondents, 142 were males (65.1 %) with a mean age of 37.6 ± 5.7 years. The modal age group was 31-40 years 153 (69.5%). The main factors considered as a hindrance to surveillance were; the cost of the tests (57.7%), failure of return of patients (50.5%) and not being aware of a surveillance program (45.2 %). The majority of the respondents were Gastroenterologists and Family Physicians. 54% of the gastroenterologists and 64% of the family physicians have never offered HCC surveillance to their patients.Conclusion:This survey highlights a knowledge gap in HCC surveillance among physicians. There is a need to make HCCsurveillance a daily routine among patients at risk by all physicians. Keywords: Surveillance, Hepatocellular Carcinoma, HBV, HCV, Cancer screening

The value of serum Hepatitis B surface antigen quantification in determining viralactivity in chronic Hepatitis B virus infection.

Background and Aims: We aimed to quantify the Serum HBsAg titres in CHBpatients, and to determine if there is an association between Serum HBsAg titres and the phase of CHB.Methods: A total of 178 consecutively presenting patients with chronic hepatitis B werestudied. The different phases of CHB were classified according to the serum HBeAg/anti-HBe status, HBV DNA concentrations and serum ALT levels, based on the European Association for the study of the liver (EASL) guidelines.Serum HBsAg titres were measured using the Elecsys HBsAg II Quant assay (Roche Diagnostics).Results: Of the total (178) patients studied, 3 (2%) were found to be in the immune tolerant phase, 10 (6%) in the immune clearance phase, 98 (55%) in the low replicative phase, and 67 (38%) in the reactivation phase. The mean values of HBsAg titres were 4.70, 4.45, 3.38, and 3.68 log IU/ml for the immune tolerant, immune clearance, inactive and reactivation phases 395 respectively. The difference in the mean value for HBsAg level across the phases of hepatitis B were found to be statistically significant (p < 0.05).Conclusion: HBsAg titres varied significantly across different phases of CHB in treatment naive patients. In addition, HBsAg titres were highest in the immune tolerant phase ofCHB andalso higher in hepatitis e antigen positive patients compared to hepatitis e antigen negative patients.Keywords:Serum Hepatitis B surface antigen Quantification, Viralactivity,Chronic Hepatitis B infectio