Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

Asgeir Johannessen (), Alexander J. Stockdale, Marc Y. R. Henrion, Edith Okeke, Moussa Seydi, Gilles Wandeler, Mark Sonderup, C. Wendy Spearman, Michael Vinikoor, Edford Sinkala, Hailemichael Desalegn, Fatou Fall, Nicholas Riches, Pantong Davwar, Mary Duguru, Tongai Maponga, Jantjie Taljaard, Philippa C. Matthews, Monique Andersson, Souleyman Mboup, Roger Sombie, Yusuke Shimakawa and Maud Lemoine
Additional contact information
Asgeir Johannessen: Vestfold Hospital
Alexander J. Stockdale: University of Liverpool
Marc Y. R. Henrion: Malawi-Liverpool-Wellcome Trust Clinical Research Programme
Edith Okeke: University of Jos
Moussa Seydi: Centre Hospitalier National Universitaire de Fann
Gilles Wandeler: University of Bern
Mark Sonderup: University of Cape Town
C. Wendy Spearman: University of Cape Town
Michael Vinikoor: University of Zambia
Edford Sinkala: University of Zambia
Hailemichael Desalegn: Vestfold Hospital
Fatou Fall: Hopital Principal de Dakar
Nicholas Riches: Liverpool School of Tropical Medicine
Pantong Davwar: University of Jos
Mary Duguru: University of Jos
Tongai Maponga: Stellenbosch University Faculty of Medicine and Health Sciences
Jantjie Taljaard: Tygerberg Hospital and Stellenbosch University
Philippa C. Matthews: University of Oxford
Monique Andersson: Stellenbosch University Faculty of Medicine and Health Sciences
Souleyman Mboup: de Surveillance Épidémiologique et de Formations (IRESSEF)
Roger Sombie: Yalgado Ouédraogo University Hospital Center
Yusuke Shimakawa: Unité d’Epidémiologie des Maladies Emergentes, Institut Pasteur
Maud Lemoine: Imperial College London

Nature Communications, 2023, vol. 14, issue 1, 1-12

Abstract: Abstract In sub-Saharan Africa, simple biomarkers of liver fibrosis are needed to scale-up hepatitis B treatment. We conducted an individual participant data meta-analysis of 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries to assess the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index and two other fibrosis biomarkers using a Bayesian bivariate model. Transient elastography was used as a reference test with liver stiffness measurement thresholds at 7.9 and 12.2kPa indicating significant fibrosis and cirrhosis, respectively. At the World Health Organization-recommended cirrhosis threshold (>2.0), aspartate aminotransferase-to-platelet ratio index had sensitivity (95% credible interval) of only 16.5% (12.5–20.5). We identified an optimised aspartate aminotransferase-to-platelet ratio index rule-in threshold (>0.65) for liver stiffness measurement >12.2kPa with sensitivity and specificity of 56.2% (50.5–62.2) and 90.0% (89.0–91.0), and an optimised rule-out threshold (

Date: 2023
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DOI: 10.1038/s41467-022-35729-w

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