Identifying Possible Hepatic Fibrosis of Hepatitis B Origin Using Non-invasive Markers: A Case-control Study in the South West Region of Cameroon

Aim: HBV infection is known to cause liver fibrosis as well as some extrahepatic manifestations. We aimed at assessing hematological changes and identifying possible hepatic fibrosis of Hepatitis B origin using non-invasive markers (NIMs).

Study Design: A hospital-based Case-control study

Place and Duration of Study: Conducted at the Buea Regional Hospital, South West Region of Cameroon from February 2016 to December 2017

Methods: We enrolled HBV infected treatment naïve patients and “healthy” controls. All participants were subjected to alanine aminotransferase (ALT) and aspartate aminotransferase (AST) measurement, Full blood count (FBC), HBsAg, anti-HBc, HIV and HCV tests. Aspartate-platelet ratio index (APRI), fibrosis based on 4 factors (FIB-4), age-platelet index (API) and AST/ALT ratio (AAR) were generated from the test results. A questionnaire was administered to collect demographic data, alcohol consumption and history of liver/kidney disease or metabolic syndrome.

Results: A total of 202 cases and 202 controls were enrolled. Hematocrit (HCT) was significantly higher (p<0.001) in cases than controls. The controls had significantly higher mean values for platelet (p=0.005), neutrophil (p=0.032) and number of individuals with AST/ALT ratio (AAR) ≥1. Liver fibrosis was significantly associated with cases than controls based on APRI (OR:6.06, CI:3.59-10.24), FIB-4 (OR:5.35, CI:2.75-10.39) and API (OR:8.02, CI:1.81-35.55). Among the HBV infected cases, 69 (34.2%), 36(17.8%) and 8(4.0%) had results indicative of fibrosis from at least 2, at least 3 and all 4 NIMs respectively. AAR detected possible fibrosis in 136 HBV infected cases of which up to 77 (56.6%) were not detected as fibrosis by the other NIMs.

Conclusion: HBV infection affects neutrophil percentage, HCT, PLT, APRI, FIB-4 and API in our study population. AAR did not prove to be a reliable NIM. Using at least 3 NIMs for HBV infected patients can significantly scale up their reliability for determining liver fibrosis in clinical practice.