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Bittaye SO, Kambi A, Tekanyi MAI, Tamba S, Sanneh L, Sisawo MM, Jatta A, Fatty G, Jeng A, Jallow MS, Leigh O, Njie R. Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients. BMC Gastroenterol 2023; 23:321. [PMID: 37730538 PMCID: PMC10510158 DOI: 10.1186/s12876-023-02952-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND As a result of the lack of screening programs and the difficulty in making a proper diagnosis, the majority of hepatocellular carcinoma (HHC) patients present late in low-resource countries. The study therefore assesses the clinical features, stage and prognostic variables of patients with HCC in The Gambia. METHODS From December 2015 to January 2019, patients with a confirmed diagnosis of HCC were enrolled. All patients' medical history, ultrasound scan, FibroScan and laboratory details were collected. RESULTS Two hundred and sixty (260) patients were enrolled. The mean age of HCC patients was 40 years, and 210 (80.7%) of them were male. The most common gastrointestinal symptoms were early satiety 229 (88.1%) and abdominal pain 288 (87.7%), while the most common constitutional symptoms were weight loss 237 (91.2%) and easy fatiguability 237 (91.2%). Hepatomegaly 205 (78.8%) was the most common sign. On ultrasound scan, lesions were mostly multifocal 175 (67.3%), and the median FibroScan score was 75 kPa. The median fibrosis 4 and aspartate transferase platelet ratio index were 4.6 and 2.2, respectively. Hepatitis B surface antigen (HBsAg) was positive in 170 (65.4%) patients, and the median AFP level was 3263 ng/ml. HCC patients with positive HBsAg were more likely to be male 145 (85.3%) vs 62 (72.1%) (p = 0.011), much younger 39.9 vs 51.4 yrs (p = < 0.0001), more likely to have abdominal pain 156 (91.8%) vs 68 (79.1%) (p = 0.002), jaundice 78 (45.9%) vs 29 (33.7%) (p = 0.042), dark urine 117 (68.8%) vs 46 (53.5%) (p = 0.018), raised transaminases (Aspartate transaminases 224.5 (32-7886) vs 153 (18-610), p = < 0.01, Alanine transferases 71 (5-937) vs 47 (8-271), p = < 0.001) and decreased platelet count 207 (33-941) vs 252 (52- 641) (p = 0.021) compared to patients with HCC who were HBsAg-negative. CONCLUSIONS The prognosis of patients with HCC is poor in developing countries such as The Gambia, where screening programs and treatment modalities are scarce. Young males are disproportionately affected, and HBV is a major cause of HCC in The Gambia.
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Affiliation(s)
- Sheikh Omar Bittaye
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.
| | - Abubacarr Kambi
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Momodou A I Tekanyi
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Saydiba Tamba
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Lamin Sanneh
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Momodou Musa Sisawo
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Abdoulie Jatta
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Gibril Fatty
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Adam Jeng
- Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Momodou Salieu Jallow
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
- Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ousman Leigh
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
- Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- American International University, Serekunda, Gambia
| | - Ramou Njie
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
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Shimakawa Y, Ndow G, Njie R, Njai HF, Takahashi K, Akbar SMF, Cohen D, Nayagam S, Jeng A, Ceesay A, Sanneh B, Baldeh I, Imaizumi M, Moriyama K, Aoyagi K, D'Alessandro U, Mishiro S, Chemin I, Mendy M, Thursz MR, Lemoine M. Hepatitis B Core-related Antigen: An Alternative to Hepatitis B Virus DNA to Assess Treatment Eligibility in Africa. Clin Infect Dis 2020; 70:1442-1452. [PMID: 31102406 DOI: 10.1093/cid/ciz412] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To eliminate hepatitis B virus (HBV) infection, it is essential to scale up testing and treatment. However, conventional tools to assess treatment eligibility, particularly nucleic acid testing (NAT) to quantify HBV DNA, are hardly available and affordable in resource-limited countries. We therefore assessed the performance of a novel immunoassay, hepatitis B core-related antigen (HBcrAg), as an inexpensive (US$ <15/assay) alternative to NAT to diagnose clinically important HBV DNA thresholds (≥2000, ≥20 000, and ≥200 000 IU/mL) and to select patients for antiviral therapy in Africa. METHODS Using a well-characterized cohort of treatment-naive patients with chronic HBV infection in The Gambia, we evaluated the accuracy of serum HBcrAg to diagnose HBV DNA levels and to indicate treatment eligibility determined by the American Association for the Study of Liver Diseases, based on reference tests (HBV DNA, hepatitis B e antigen, alanine aminotransferase, liver histopathology, and/or FibroScan). RESULTS A total of 284 treatment-naive patients were included in the analysis. The area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity of serum HBcrAg were 0.88 (95% confidence interval [CI], .82-.93), 83.3%, and 83.9%, respectively, to diagnose HBV DNA ≥2000 IU/mL; and 0.94 (95% CI, .88-.99), 91.4%, and 93.2% for ≥200 000 IU/mL. A simplified treatment algorithm using HBcrAg without HBV DNA showed high AUROC (0.91 [95% CI, .88-.95]) with a sensitivity of 96.6% and specificity of 85.8%. CONCLUSIONS HBcrAg might be an accurate alternative to HBV DNA quantification as a simple and inexpensive tool to identify HBV-infected patients in need of antiviral therapy in low- and middle-income countries.
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Affiliation(s)
- Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Gibril Ndow
- Medical Research Council (MRC) Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Liver Unit, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Ramou Njie
- The Gambia Hepatitis Intervention Study, International Agency for Research on Cancer (IARC), MRC Unit, Fajara, The Gambia
| | - Harr Freeya Njai
- Medical Research Council (MRC) Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | | | - Damien Cohen
- Institut national de la santé et de la recherche médicale U1052, Centre national de la recherche scientifique UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Shevanthi Nayagam
- Liver Unit, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Adam Jeng
- Medical Research Council (MRC) Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Amie Ceesay
- Medical Research Council (MRC) Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bakary Sanneh
- National Public Health Laboratory, Banjul, The Gambia
| | | | | | | | - Katsumi Aoyagi
- Research and Development Division, Fujirebio Inc, Tokyo, Japan
| | - Umberto D'Alessandro
- Medical Research Council (MRC) Unit, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Shunji Mishiro
- Department of Medical Sciences, Toshiba General Hospital, Tokyo
| | - Isabelle Chemin
- Department of Pathology, Ehime University Graduate School of Medicine, Japan
| | - Maimuna Mendy
- International Agency for Research on Cancer, Lyon, France
| | - Mark R Thursz
- Liver Unit, Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Maud Lemoine
- Liver Unit, Department of Surgery and Cancer, Imperial College London, United Kingdom
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Shimakawa Y, Njie R, Ndow G, Vray M, Mbaye PS, Bonnard P, Sombié R, Nana J, Leroy V, Bottero J, Ingiliz P, Post G, Sanneh B, Baldeh I, Suso P, Ceesay A, Jeng A, Njai HF, Nayagam S, D'Alessandro U, Chemin I, Mendy M, Thursz M, Lemoine M. Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa. J Hepatol 2018; 69:776-784. [PMID: 30104154 DOI: 10.1016/j.jhep.2018.05.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/02/2018] [Accepted: 05/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS To eliminate hepatitis B virus (HBV) infection, it is essential to scale up antiviral treatment through decentralized services. However, access to the conventional tools to assess treatment eligibility (liver biopsy/Fibroscan®/HBV DNA) is limited and not affordable in resource-limited countries. We developed and validated a simple score to easily identify patients in need of HBV treatment in Africa. METHODS As a reference, we used treatment eligibility determined by the European Association for the Study of the Liver based on alanine aminotransferase (ALT), liver histology and/or Fibroscan and HBV DNA. We derived a score indicating treatment eligibility by a stepwise logistic regression using a cohort of chronic HBV infection in The Gambia (n = 804). We subsequently validated the score in an external cohort of HBV-infected Africans from Senegal, Burkina Faso, and Europe (n = 327). RESULTS Out of several parameters, two remained in the final model, namely HBV e antigen (HBeAg) and ALT level, constituting a simple score (treatment eligibility in Africa for the hepatitis B virus: TREAT-B). The score demonstrated a high area under the receiver operating characteristic curve (0.85, 95% CI 0.79-0.91) in the validation set. The score of 2 and above (HBeAg-positive and ALT ≥20 U/L or HBeAg-negative and ALT ≥40 U/L) had a sensitivity and specificity for treatment eligibility of 85% and 77%, respectively. The sensitivity and specificity of the World Health Organization criteria based on the aspartate aminotransferase-to-platelet ratio index (APRI) and ALT were 90% and 40%, respectively. CONCLUSIONS A simple score based on HBeAg and ALT had a high diagnostic accuracy for the selection of patients for HBV treatment. This score could be useful in African settings. LAY SUMMARY Limited access to the diagnostic tools used to assess treatment eligibility (liver biopsy/Fibroscan/hepatitis B virus DNA) has been an obstacle to the scale up of hepatitis B treatment programs in low- and middle-income countries. Using the data from African patients with chronic HBV infection, we developed and validated a new simple diagnostic score for treatment eligibility, which only consists of hepatitis B virus e antigen and alanine aminotransferase level. The diagnostic accuracy of the score for selecting patients for HBV treatment was high and could be useful in African settings.
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Affiliation(s)
- Yusuke Shimakawa
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France.
| | - Ramou Njie
- The Gambia Hepatitis Intervention Study, IARC, c/o MRC Unit, Fajara, The Gambia
| | - Gibril Ndow
- Medical Research Council (MRC) Unit, The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia; Department of Surgery and Cancer, Liver Unit, Imperial College London, UK
| | - Muriel Vray
- Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France; Unité d'Épidémiologie des Maladies Infectieuses, Institut Pasteur de Dakar, Dakar, Senegal
| | - Papa Saliou Mbaye
- Département d'Hépato-gastroentérologie, Hôpital Principal, Dakar, Senegal
| | | | - Roger Sombié
- Département d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso
| | - Jean Nana
- Université Grenoble Alpes, Grenoble, France
| | | | - Julie Bottero
- Infectious Disease Department, St Antoine Hospital, AP-HP, Paris, France
| | | | - Gerrit Post
- Center for Infectiology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bakary Sanneh
- National Public Health Laboratory, Banjul, The Gambia
| | | | - Penda Suso
- Medical Research Council (MRC) Unit, The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Amie Ceesay
- Medical Research Council (MRC) Unit, The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Adam Jeng
- Medical Research Council (MRC) Unit, The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Harr Freeya Njai
- Medical Research Council (MRC) Unit, The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Shevanthi Nayagam
- Department of Surgery and Cancer, Liver Unit, Imperial College London, UK
| | - Umberto D'Alessandro
- Medical Research Council (MRC) Unit, The Gambia at the London School of Hygiene and Tropical Medicine, The Gambia
| | - Isabelle Chemin
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Mark Thursz
- Department of Surgery and Cancer, Liver Unit, Imperial College London, UK
| | - Maud Lemoine
- Department of Surgery and Cancer, Liver Unit, Imperial College London, UK.
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4
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Ghosh S, Sow A, Guillot C, Jeng A, Ndow G, Njie R, Toure S, Diop M, Mboup S, Kane CT, Lemoine M, Thursz M, Zoulim F, Mendy M, Chemin I. Implementation of an in-house quantitative real-time polymerase chain reaction method for Hepatitis B virus quantification in West African countries. J Viral Hepat 2016; 23:897-904. [PMID: 27353593 DOI: 10.1111/jvh.12561] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022]
Abstract
Hepatitis B virus (HBV) is a major cause of chronic liver disease worldwide. HBV infection is diagnosed by serological tests, while real-time polymerase chain reaction (qRT-PCR) assays are used to quantify viral load, which is a crucial parameter to determine viral replication and to monitor antiviral treatments. However, measuring viral load in resource-limited countries remains nonsystematic, due to the high cost of commercial kits. Here, we describe the development, validation and implementation of a low-cost, in-house qRT-PCR assay to monitor HBV viral load in chronic carriers enrolled in the PROLIFICA programme in the Gambia and Senegal. Over 1500 HBsAg-positive patients, including 210 chronically infected HBV patients, who were given antiviral treatment (tenofovir), were monitored by qRT-PCR using the SYBR Green- and HBV-specific primers. Twenty-four tenofovir-treated patients were followed up and their viral load was tested every 3 months over the 12-month experimental time course. Compared to commercial assays, our in-house assay was shown to be (i) highly reliable, with good intra- and interassay reproducibility over a wide range (45-4.5 × 108 copies mL-1 ), (ii) very similar in the viral loads detected (R2 = .90), (iii) highly sensitive, as it detected loads as low as 30 copies mL-1 (~5 IU mL-1 ), (iv) cheaper (2- to 3-fold), (v) easier to implement and (vi) more rapid. Based on our experience, we recommend this assay as a reliable alternative to commercial assays, for monitoring HBV viraemia in resource-limited, highly endemic countries to reduce the cost and technical obstacles associated with commercial kits.
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Affiliation(s)
- S Ghosh
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie de Lyon Université Claude Bernard, Lyon, France
| | - A Sow
- La Dantec, Dakar, Senegal
| | - C Guillot
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie de Lyon Université Claude Bernard, Lyon, France
| | - A Jeng
- MRC, The Gambia Unit, Banjul, The Gambia
| | - G Ndow
- MRC, The Gambia Unit, Banjul, The Gambia
- Department of Hepatology, Imperial College London, London, UK
| | - R Njie
- MRC, The Gambia Unit, Banjul, The Gambia
- Laboratory Services and Biobank Group (DIR/LSB), IARC, Lyon, France
| | - S Toure
- MRC, The Gambia Unit, Banjul, The Gambia
| | - M Diop
- La Dantec, Dakar, Senegal
| | | | | | - M Lemoine
- Department of Hepatology, Imperial College London, London, UK
| | - M Thursz
- Department of Hepatology, Imperial College London, London, UK
| | - F Zoulim
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie de Lyon Université Claude Bernard, Lyon, France
- Department of Hepatology, Hospices Civils de Lyon, Lyon, France
| | - M Mendy
- Laboratory Services and Biobank Group (DIR/LSB), IARC, Lyon, France
| | - I Chemin
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie de Lyon Université Claude Bernard, Lyon, France.
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5
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Lemoine M, Shimakawa Y, Njie R, Taal M, Ndow G, Chemin I, Ghosh S, Njai HF, Jeng A, Sow A, Toure-Kane C, Mboup S, Suso P, Tamba S, Jatta A, Sarr L, Kambi A, Stanger W, Nayagam S, Howell J, Mpabanzi L, Nyan O, Corrah T, Whittle H, Taylor-Robinson SD, D'Alessandro U, Mendy M, Thursz MR. Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study. Lancet Glob Health 2016; 4:e559-67. [PMID: 27443781 DOI: 10.1016/s2214-109x(16)30130-9] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/05/2016] [Accepted: 06/07/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity and mortality remain high in sub-Saharan Africa. Identification and treatment of asymptomatic people with chronic HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who had significant liver disease in need of treatment. METHODS Between Dec 7, 2011, and Jan 24, 2014, individuals living in randomly selected communities in western Gambia were offered hepatitis B surface antigen (HBsAg) screening via a point-of-care test. The test was also offered to potential blood donors attending the central hospital in the capital, Banjul. HBsAg-positive individuals were invited for a comprehensive liver assessment and were offered treatment according to international guidelines. We defined linkage to care as visiting the liver clinic at least once. Eligibility for treatment was judged in accordance with the 2012 European Association for the Study of the Liver guidelines. FINDINGS HBsAg screening was accepted by 5980 (weighted estimate 68·9%, 95% CI 65·0-72·4) of 8170 adults from 27 rural and 27 urban communities and 5559 (81·4%, 80·4-82·3) of 6832 blood donors. HBsAg was detected in 495 (8·8%, 7·9-9·7) individuals in communities and 721 (13·0%, 12·1-13·9) blood donors. Prevalence was higher in men (239 [10·5%, 8·9-12·1] of 2328 men vs 256 [7·6%, 6·5-8·7] of 3652 women; p=0·004) and middle-aged participants. Linkage to care was high in the communities, with 402 (81·3%) of 495 HBsAg-positive individuals attending the clinic. However, only 300 (41·6%) of 721 HBsAg-positive people screened at the blood bank linked into care. Of those who attended the clinic, 18 (4·4%, 2·5-7·7) patients from the communities and 29 (9·7%, 6·8-13·6) from the blood bank were eligible for treatment. Male sex was strongly associated with treatment eligibility (odds ratio 4·35, 1·50-12·58; p=0·007). INTERPRETATION HBV infection remains highly prevalent in The Gambia. The high coverage of community-based screening, good linkage into care, and the small proportion of HBsAg carriers who need treatment suggest that large-scale screening and treatment programmes are feasible in sub-Saharan Africa. FUNDING European Commission (FP7).
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Affiliation(s)
- Maud Lemoine
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Yusuke Shimakawa
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Unité d'Épidémiologie des Maladies Émergentes, Institut Pasteur, Paris, France
| | - Ramou Njie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Makie Taal
- Ministry of Health and Social Welfare, Banjul, The Gambia
| | - Gibril Ndow
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia; Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Isabelle Chemin
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Sumantra Ghosh
- INSERM U1052, CNRS UMR5286, Centre de Recherche en Cancérologie, Université Claude Bernard, Lyon, France
| | - Harr F Njai
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Adam Jeng
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Amina Sow
- Department of bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Coumba Toure-Kane
- Department of bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Souleymane Mboup
- Department of bacteriology and Virology, CHU Le Dantec, Dakar, Senegal
| | - Penda Suso
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Saydiba Tamba
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Abdullah Jatta
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Louise Sarr
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Aboubacar Kambi
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - William Stanger
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Shevanthi Nayagam
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Jessica Howell
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK
| | - Liliane Mpabanzi
- Department of Surgery, Maastricht University Medical Centre, Maastricht University, Netherlands; NUTRIM School of Nutrition, Toxicology and Metabolism, Maastricht University, Netherlands; Hepato-Pancreato-Biliary and Liver Transplant Surgery, Royal Free Hospital, University College London, London, UK
| | - Ousman Nyan
- Edward Francis Small Teaching Hospital (EFSTH), Banjul, The Gambia
| | - Tumani Corrah
- Medical Research Council Laboratories, The Gambia Unit, Fajara, The Gambia
| | - Hilton Whittle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Maimuna Mendy
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Mark R Thursz
- Division of Digestive Diseases, St Mary's Hospital, Imperial College London, London, UK.
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6
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Fye HKS, Wright-Drakesmith C, Kramer HB, Camey S, da Costa AN, Jeng A, Bah A, Kirk GD, Sharif MIF, Ladep NG, Okeke E, Hainaut P, Taylor-Robinson SD, Kessler BM, Mendy ME. Protein profiling in hepatocellular carcinoma by label-free quantitative proteomics in two west African populations. PLoS One 2013; 8:e68381. [PMID: 23935864 PMCID: PMC3728326 DOI: 10.1371/journal.pone.0068381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/28/2013] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Haddy K. S. Fye
- Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology - University of Oxford, Oxford, Oxfordshire, United Kingdom
- Department of Disease Control and Elimination, MRC Unit (UK) The Gambia Laboratories, Fajara, Banjul, The Gambia
| | - Cynthia Wright-Drakesmith
- Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology - University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Holger B. Kramer
- Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology - University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Suzi Camey
- Laboratory Services and Bio-bank Group, International Agency for Research on Cancer, Lyon, France
- Departamento de Estatistica, Instituto de Matematica, Universidade Federal do Rio Grande do Sul, Rio Grande, Brazil
| | - Andre Nogueira da Costa
- Laboratory Services and Bio-bank Group, International Agency for Research on Cancer, Lyon, France
| | - Adam Jeng
- Department of Disease Control and Elimination, MRC Unit (UK) The Gambia Laboratories, Fajara, Banjul, The Gambia
| | - Alasana Bah
- Department of Disease Control and Elimination, MRC Unit (UK) The Gambia Laboratories, Fajara, Banjul, The Gambia
| | - Gregory D. Kirk
- Department of Epidemiology - Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mohamed I. F. Sharif
- Liver Unit - Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Nimzing G. Ladep
- Liver Unit - Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Edith Okeke
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Pierre Hainaut
- Laboratory Services and Bio-bank Group, International Agency for Research on Cancer, Lyon, France
- The International Prevention Research Institute, Lyon, France
| | - Simon D. Taylor-Robinson
- Liver Unit - Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, London, United Kingdom
| | - Benedikt M. Kessler
- Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology - University of Oxford, Oxford, Oxfordshire, United Kingdom
| | - Maimuna E. Mendy
- Laboratory Services and Bio-bank Group, International Agency for Research on Cancer, Lyon, France
- Department of Disease Control and Elimination, MRC Unit (UK) The Gambia Laboratories, Fajara, Banjul, The Gambia
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Jobarteh M, Malfroy M, Peterson I, Jeng A, Sarge-Njie R, Alabi A, Peterson K, Cotten M, Hall A, Rowland-Jones S, Whittle H, Tedder R, Jaye A, Mendy M. Seroprevalence of hepatitis B and C virus in HIV-1 and HIV-2 infected Gambians. Virol J 2010; 7:230. [PMID: 20843322 PMCID: PMC2949835 DOI: 10.1186/1743-422x-7-230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 09/15/2010] [Indexed: 12/12/2022] Open
Abstract
Background The prevalence of HIV/hepatitis co-infection in sub-Saharan Africa is not well documented, while both HIV and HBV are endemic in this area. Objective The aim of this study is to determine the seroprevalence of HBV and HCV virus in HIV-infected subjects in the Gambia. Methods Plasma samples from HIV infected patients (190 individuals with clinically defined AIDS and 382 individuals without AIDS) were tested retrospectively for the presence of HBV sero-markers and for serum HBV DNA, screened for HCV infection by testing for anti-HCV antibody and HCV RNA. Results HBsAg prevalence in HIV-positive individuals is 12.2%. HIV/HBV co-infected individuals with CD4 count of <200 cells uL-1 have a higher HBV DNA viral load than patients with higher CD4 count (log 4.0 vs. log 2.0 DNA copies/ml, p < 0.05). Males (OR = 1.8, 95% CI: 1.0, 3.2) were more likely to be HBsAg positive than female. HCV seroprevalence was 0.9% in HIV-positive individuals. Conclusion The prevalence of HBsAg carriage in HIV- infected Gambians is similar to that obtained in the general population. However co-infected individuals with reduced CD4 levels, indicative of AIDS had higher prevalence of HBeAg retention and elevated HBV DNA levels compared to non-AIDS patients with higher CD4 count.
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Affiliation(s)
- Modou Jobarteh
- Medical Research Council, Fajara, P O Box 273, Banjul, The Gambia
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