Hepatitis B in Sub-Saharan Africa

No Abstrac

Prevalence of irritable bowel syndrome: A community survey in an African population

Background : Irritable bowel syndrome (IBS) has been reported to be common in the West. Community surveys are lacking in the African setting. We determined the prevalence of IBS in a rural community setting in Nigeria. Method : Questionnaires were administered to consenting individuals. Subjects satisfying the Rome II criteria for IBS were invited for physical examination at a health center to identify the presence of "alarm factors." Results : One hundred forty (31.6%) of the 443 evaluated individuals fulfilled the Rome II criteria for IBS, with a male-to-female ratio of 1.37:1 (P= .11). The prevalence of IBS was highest (39.3%) in the third decade, followed by 25% in the fourth decade (P= .009). Ninety-six (67%) IBS individuals had the alternating pattern of diarrhea and constipation, whereas 28 (20%) and 19 (13%) had constipation and diarrhea subtypes, respectively. Conclusion : IBS as diagnosed by the Rome II criteria has a high prevalence in the African rural population, as obtained elsewhere.Contexte: Irritable Syndrome (IBS) a \ue9t\ue9 signal\ue9 \ue0 \ueatre commune \ue0 l\u2019Ouest. Enqu\ueates communautaires font d\ue9faut dans le contexte africain. Nous avons d\ue9termin\ue9 la pr\ue9valence de IBS dans un milieu rural. communaut\ue9 d\ue9fi nition dans le Nig\ue9ria. M\ue9thode: Questionnaires ont \ue9t\ue9 administr\ue9 aux personnes consentantes. Sujets de satisfaction de la Rome II crit\ue8res d\u2019IBS ont \ue9t\ue9 invit\ue9s pour l\u2019examen physique dans un centre de sant\ue9 \ue0 identifi er la pr\ue9sence de \u201c alarme les facteurs \u201d. R\ue9sultats: Un cent et quarante (31,6 %) des individus \ue9valu\ue9es 443 rempli le Rome Crit\ue8res II IBS avec un m\ue2le \ue0 ratio f\ue9minin de 1.37:1 (p = 0,11) .la pr\ue9valence IBS \ue9tait plus \ue9lev\ue9 dans la troisi\ue8me d\ue9cennie (39.3 %), suivie de 25 % dans le quatri\ue8me dix ans (p = 0.009). Quatre-vingt-seize (67 %) IBS personnes avaient le mod\ue8le d\u2019alternance de la diarrh\ue9e et constipation, alors que 28 (20 %) et 19 (13 %) avaient constipation et la diarrh\ue9e subtypes respectivement. Conclusion: IBS comme un diagnostic par les crit\ue8res de Rome II a une haute pr\ue9valence dans la population rurale africaine comme obtenu ailleurs

Prevention of Liver Fibrosis and Cancer in Africa: The PROLIFICA project – a collaborative study of hepatitis B-related liver disease in West Africa

Hepatitis B virus (HBV) infection causes a spectrum of acute and chronic liver disease ranging from inactive chronic carrier status to progressive chronic hepatitis, culminating in end-stage cirrhosis and liver cancer. In sub-Saharan Africa, HBV infection is endemic and the HBV-related disease burden is high, making HBV a signficant threat to health in the African continent. The European Union-funded Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) project was established in 2011, with the central directive to reduce the incidence of HBV-related liver cancer in West Africa. In this editorial, we outline some of the achievements and challenges of the PROLIFICA platform in West Africa, highlighting the the importance of collaborative studies in Africa

Hepatitis B Co-Infection is Associated with Poorer Survival of HIV-Infected Patients on Highly Active Antiretroviral Therapy in West Africa

Background: Hepatitis B has been reported to be high in HIV-infected African populations. However, the impact of this co-infection on the survival of HIV-infected Africans on long-term highly active antiretroviral therapy (HAART) remains poorly characterised. We investigated the impact of HBV/HIV co-infection on survival of HIV infected patients undergoing antiretroviral therapy in a West African population. Methods: This was a clinic-based cohort study of HIV-infected adults enrolled in Nigeria, West Africa. Study subjects (9,758) were screened for hepatitis B and hepatitis C at HAART initiation. Kaplan-Meier survival and Cox proportional hazards models were used to estimate probability of survival and to identify predictors of mortality respectively, based on hepatitis B surface antigen status. All patients had signed an informed written consent before enrolment into the study; and we additionally obtained permission for secondary use of data from the Harvard institutional review board. Results: Patients were followed up for a median of 41 months (interquartile range: 30–62 months) during which, 181 (1.9%) patients died. Most of the deaths; 143 (79.0%) occurred prior to availability of Tenofovir. Among those that were on antiretroviral therapy, hepatitis B co-infected patients experienced a significantly lower survival than HIV mono-infected patients at 74 months of follow up (94% vs. 97%; p=0.0097). Generally, hepatitis B co-infection: HBsAg-positive/HIV-positive (Hazards Rate [HR]; 1.5: 95% CI 1.09–2.11), co-morbid tuberculosis (HR; 2.2: 95% CI 1.57–2.96) and male gender (HR; 1.5: 95% CI 1.08–2.00) were significantly predictive of mortality. Categorising the patients based on use of Tenofovir, HBV infection failed to become a predictor of mortality among those on Tenofovir-containing HAART. Conclusions: HBsAg-positive status was associated with reduced survival and was an independent predictor of mortality in this African HIV cohort on HAART. However, Tenofovir annulled the impact of HBV on mortality of HIV patients in the present study cohort

Protein profiling in hepatocellular carcinoma by label-free quantitative proteomics in two west african populations

Background: Hepatocellular Carcinoma is the third most common cause of cancer related death worldwide, often diagnosed by measuring serum AFP; a poor performance stand-alone biomarker. With the aim of improving on this, our study focuses on plasma proteins identified by Mass Spectrometry in order to investigate and validate differences seen in the respective proteomes of controls and subjects with LC and HCC. Methods: Mass Spectrometry analysis using liquid chromatography electro spray ionization quadrupole time-of-flight was conducted on 339 subjects using a pooled expression profiling approach. ELISA assays were performed on four significantly differentially expressed proteins to validate their expression profiles in subjects from the Gambia and a pilot group from Nigeria. Results from this were collated for statistical multiplexing using logistic regression analysis. Results: Twenty-six proteins were identified as differentially expressed between the three subject groups. Direct measurements of four; hemopexin, alpha-1-antitrypsin, apolipoprotein A1 and complement component 3 confirmed their change in abundance in LC and HCC versus control patients. These trends were independently replicated in the pilot validation subjects from Nigeria. The statistical multiplexing of these proteins demonstrated performance comparable to or greater than ALT in identifying liver cirrhosis or carcinogenesis. This exercise also proposed preliminary cut offs with achievable sensitivity, specificity and AUC statistics greater than reported AFP averages. Conclusions: The validated changes of expression in these proteins have the potential for development into highperformance tests usable in the diagnosis and or monitoring of HCC and LC patients. The identification of sustained expression trends strengthens the suggestion of these four proteins as worthy candidates for further investigation in the context of liver disease. The statistical combinations also provide a novel inroad of analyses able to propose definitive cutoffs and combinations for evaluation of performance

Protein profiling in hepatocellular carcinoma by label-free quantitative proteomics in two west african populations.

Background Hepatocellular Carcinoma is the third most common cause of cancer related death worldwide, often diagnosed by measuring serum AFP; a poor performance stand-alone biomarker. With the aim of improving on this, our study focuses on plasma proteins identified by Mass Spectrometry in order to investigate and validate differences seen in the respective proteomes of controls and subjects with LC and HCC. Methods Mass Spectrometry analysis using liquid chromatography electro spray ionization quadrupole time-of-flight was conducted on 339 subjects using a pooled expression profiling approach. ELISA assays were performed on four significantly differentially expressed proteins to validate their expression profiles in subjects from the Gambia and a pilot group from Nigeria. Results from this were collated for statistical multiplexing using logistic regression analysis. Results Twenty-six proteins were identified as differentially expressed between the three subject groups. Direct measurements of four; hemopexin, alpha-1-antitrypsin, apolipoprotein A1 and complement component 3 confirmed their change in abundance in LC and HCC versus control patients. These trends were independently replicated in the pilot validation subjects from Nigeria. The statistical multiplexing of these proteins demonstrated performance comparable to or greater than ALT in identifying liver cirrhosis or carcinogenesis. This exercise also proposed preliminary cut offs with achievable sensitivity, specificity and AUC statistics greater than reported AFP averages. Conclusions The validated changes of expression in these proteins have the potential for development into high-performance tests usable in the diagnosis and or monitoring of HCC and LC patients. The identification of sustained expression trends strengthens the suggestion of these four proteins as worthy candidates for further investigation in the context of liver disease. The statistical combinations also provide a novel inroad of analyses able to propose definitive cut-offs and combinations for evaluation of performance

Hepatitis B in Sub-Saharan Africa

Hepatitis B virus (HBV) infection causes a spectrum of acute and chronic liver disease, ranging from inactive chronic carrier status to progressive chronic hepatitis, leading to end-stage cirrhosis and primary liver cancer. In sub-Saharan Africa, over 8% of the population has chronic HBV carriage with a high risk for progressive liver disease. HBV-related hepatocellular carcinoma is the most common cancer among men and third most common among women. HBV therefore represents a critical threat to health in the African continent

Prevalence of irritable bowel syndrome: A community survey in an African population

Background : Irritable bowel syndrome (IBS) has been reported to be common in the West. Community surveys are lacking in the African setting. We determined the prevalence of IBS in a rural community setting in Nigeria. Method : Questionnaires were administered to consenting individuals. Subjects satisfying the Rome II criteria for IBS were invited for physical examination at a health center to identify the presence of "alarm factors." Results : One hundred forty (31.6%) of the 443 evaluated individuals fulfilled the Rome II criteria for IBS, with a male-to-female ratio of 1.37:1 (P= .11). The prevalence of IBS was highest (39.3%) in the third decade, followed by 25% in the fourth decade (P= .009). Ninety-six (67%) IBS individuals had the alternating pattern of diarrhea and constipation, whereas 28 (20%) and 19 (13%) had constipation and diarrhea subtypes, respectively. Conclusion : IBS as diagnosed by the Rome II criteria has a high prevalence in the African rural population, as obtained elsewhere.Contexte: Irritable Syndrome (IBS) a été signalé à être commune à l’Ouest. Enquêtes communautaires font défaut dans le contexte africain. Nous avons déterminé la prévalence de IBS dans un milieu rural. communauté défi nition dans le Nigéria. Méthode: Questionnaires ont été administré aux personnes consentantes. Sujets de satisfaction de la Rome II critères d’IBS ont été invités pour l’examen physique dans un centre de santé à identifi er la présence de “ alarme les facteurs ”. Résultats: Un cent et quarante (31,6 %) des individus évaluées 443 rempli le Rome Critères II IBS avec un mâle à ratio féminin de 1.37:1 (p = 0,11) .la prévalence IBS était plus élevé dans la troisième décennie (39.3 %), suivie de 25 % dans le quatrième dix ans (p = 0.009). Quatre-vingt-seize (67 %) IBS personnes avaient le modèle d’alternance de la diarrhée et constipation, alors que 28 (20 %) et 19 (13 %) avaient constipation et la diarrhée subtypes respectivement. Conclusion: IBS comme un diagnostic par les critères de Rome II a une haute prévalence dans la population rurale africaine comme obtenu ailleurs