London School of Hygiene & Tropical Medicine

The study also investigated the impact of Tenofovir Disoproxil Fumarate on the survival of HBV-infected patients with cirrhosis.  Published in the Lancet Global Health, the findings highlight the urgent need for interventions and early screening programs for liver disease in Africa.

Chronic liver disease, particularly caused by viral hepatitis B and C, is a leading cause of premature death in sub-Saharan Africa. However, there is a lack of well-established treatment and management programs for cirrhosis and cirrhosis and hepatocellular carcinoma (HCC) in this region. The study aimed to fill this gap in knowledge and provide valuable insights into the efficacy of antiviral therapy among HBV-infected patients with cirrhosis.

The researchers followed up 529 adults diagnosed with cirrhosis or HCC between 2012 and 2015 in The Gambia. Of these, 336 patients (252 with HCC and 84 with cirrhosis) were included in the analysis. 75% of were male with a median age of 42 years.

The study revealed that HBV infection was the primary cause of HCC and cirrhosis in the Gambian population, with viral hepatitis responsible for the majority of liver-related diseases in Africa. Survival rates were alarmingly low, with a median of 1.5 months for HCC patients and 17.1 months for cirrhosis patients.

In the case of HBV-infected patients with cirrhosis, the median time between diagnosis and Tenofovir initiation was 4.9 months.

“Tenofovir, a safe drug, now accessible at generic cost widely in Africa, can be a game changer by improving the survival of HBV-infected patients with cirrhosis” said Prof Maud Lemoine, senior author of the study.

The study's results highlight the importance of scaling up comprehensive screening and treatment programs for viral hepatitis and incorporating these into the updated guidelines for the prevention and management of chronic hepatitis B. The results underscore the urgent need for both early diagnosis and treatment programs for cirrhosis and HCC in Africa as well as  curative therapies for advanced liver diseases in sub-Saharan Africa.

“The WHO called for hepatitis B elimination by 2030 and aims to significantly reduce hepatitis B related mortality. Our study suggests that programmes supporting screening and early diagnosis & treatment of cirrhosis are urgently needed in Africa, where 82 million people live with hepatitis B virus,” added Prof Lemoine.

The study was part of the PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) program, which aims to address the burden of liver disease in West Africa. The program focuses on understanding liver disease severity, developing simplified diagnostics, and improving management strategies for HBV-infected individuals.

On the findings, Dr Gibril Ndow, lead author of the study said, “Our results show that antiviral therapy with Tenofovir, which is now widely accessible and affordable, can reduce hepatitis B related mortality in Africa. This calls for urgent and coordinated action to scale up hepatitis B screening and treatment programs in the region.”

These findings serve as a call to action for healthcare policymakers and stakeholders to prioritize research and efforts into the prevention, diagnosis, and treatment of cirrhosis and HCC in sub-Saharan Africa. With appropriate interventions, it is possible to mitigate the devastating impact of liver diseases and improve the overall health outcomes of affected individuals in the region.

The research was supported by funding from EC-FP7 and MRC UKRI, demonstrating the international collaboration and support for addressing the burden of liver diseases in Africa.