Hepatitis B virus (HBV) is a major global health problem. Although sub-Saharan Africa has a high proportion of the global burden of HBV, the epidemiology and clinical features of HBV in this region are poorly characterized, and access to diagnostic and treatment services remain limited. We conducted a retrospective study of HBV-infected children and adults of all age groups who were evaluated at public and private health facilities in Freetown, Sierra Leone between January 2017 and January 2019. We assessed their clinical presentation, HBV sero-markers, stages of liver disease, prevalence of cirrhosis by non-invasive tools, and the proportion of treatment eligible patients using the criteria recommended by the World Health Organization’s 2015 treatment guidelines for HBV. Logistic regression was used to identify predictors of liver cirrhosis. 163 HBV patients included in the study, with mean age 32.6 years and 65.0% (106) being males. Most (84.0%) were asymptomatic at presentation. The majority (69.9%) were classified as having HBeAg-negative chronic infection (or inactive HBsAg carrier phase), 24.5% were in the HBeAg-negative immune active phase, 3.1% had HBeAg positive hepatitis, and 2.5% were HBsAg negative. The median Aspartate aminotransferase to Platelet Ratio (APRI) and Fibrosis-4 (FIB-4) scores were 0.37 and 0.80, respectively. The prevalence of cirrhosis was 7.6% and 6.2%, estimated by the APRI and FIB-4 scores, respectively. About 20.0% of patients were eligible for treatment with antiviral agents. Based on APRI scores, the presence of any symptom [adjusted odds ratio (aOR) 20.0, 95% confidence interval (CI) (4.1–85.9); p < 0.001], elevated direct bilirubin [aOR 12.1, 95% CI (1.9–63.0); p = 0.003], and elevated total bilirubin [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] were independent predictors of cirrhosis. Although most patients with HBV infection were asymptomatic, the prevalence of liver cirrhosis and proportion of patients requiring antiviral treatment were substantial. This small study from a hyperendemic setting in Sierra Leone suggests that routine population-based screening may increase early detection and linkage of HBV patients to care before development of complications. Larger studies are needed to confirm our findings.

中文翻译：

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塞拉利昂弗里敦乙型肝炎病毒感染患者血清标志物的流行率和肝硬化的无创评估：一项横断面研究

乙型肝炎病毒 (HBV) 是一个主要的全球健康问题。尽管撒哈拉以南非洲在全球 HBV 负担中所占比例很高，但该地区 HBV 的流行病学和临床特征的特征很差，获得诊断和治疗服务的机会仍然有限。我们对 2017 年 1 月至 2019 年 1 月在塞拉利昂弗里敦的公共和私人医疗机构接受评估的所有年龄组的 HBV 感染儿童和成人进行了回顾性研究。我们评估了他们的临床表现、HBV 血清标志物、分期肝病、非侵入性工具导致的肝硬化患病率，以及使用世界卫生组织 2015 年 HBV 治疗指南推荐的标准进行治疗的患者比例。Logistic 回归用于确定肝硬化的预测因子。研究中包括 163 名 HBV 患者，平均年龄 32.6 岁，65.0% (106) 为男性。大多数 (84.0%) 在就诊时没有症状。大多数（69.9%）被归类为 HBeAg 阴性慢性感染（或非活动性 HBsAg 携带期），24.5% 处于 HBeAg 阴性免疫活动期，3.1% 患有 HBeAg 阳性肝炎，2.5% 为 HBsAg 阴性。天冬氨酸转氨酶与血小板比率 (APRI) 和 Fibrosis-4 (FIB-4) 的中位数分别为 0.37 和 0.80。根据 APRI 和 FIB-4 评分估计，肝硬化的患病率分别为 7.6% 和 6.2%。大约 20.0% 的患者有资格接受抗病毒药物治疗。根据 APRI 评分，是否存在任何症状 [调整优势比 (aOR) 20.0，95% 置信区间 (CI) (4.1–85.9)；p < 0.001]，直接胆红素升高 [aOR 12.1，95% 置信区间 (1.9–63.0)；p = 0.003]，总胆红素升高 [aOR 16.1, 95% CI (3.2–80.8); p = 0.001] 是肝硬化的独立预测因子。尽管大多数 HBV 感染患者无症状，但肝硬化的患病率和需要抗病毒治疗的患者比例很大。这项来自塞拉利昂高流行环境的小型研究表明，常规的基于人群的筛查可能会增加 HBV 患者的早期检测和联系，以便在出现并发症之前进行护理。需要更大规模的研究来证实我们的发现。肝硬化的患病率和需要抗病毒治疗的患者比例很高。这项来自塞拉利昂高流行环境的小型研究表明，常规的基于人群的筛查可能会增加 HBV 患者的早期检测和联系，以便在出现并发症之前进行护理。需要更大规模的研究来证实我们的发现。肝硬化的患病率和需要抗病毒治疗的患者比例很高。这项来自塞拉利昂高流行环境的小型研究表明，常规的基于人群的筛查可能会增加 HBV 患者的早期检测和联系，以便在出现并发症之前进行护理。需要更大规模的研究来证实我们的发现。