Testing for hepatitis-B virus in the Prolifica project in Gambia (Imperial College London)
2 July 2018. An international research team developed a simple blood testing process to diagnose hepatitis-B at a small fraction of the cost as current methods. Researchers from Imperial College London, with colleagues from the U.K., France, and Gambia describe their techniques in yesterday’s issue of Journal of Hepatology.
Hepatitis-B is a life-threatening viral infection of the liver, which if becomes chronic can cause cirrhosis — scarring of liver tissue — and liver cancer. The hepatitis-B virus is spread through blood or contact with other bodily fluids, such as from mother to child in pregnancy. World Health Organization says hepatitis-B is a global public health problem affecting some 257 million people now living with the disease and causing some 887,000 deaths in 2015. While a vaccine is readily available to prevent hepatitis-B, there are now no cures. Another problem with hepatitis-B is there are few, if any, immediate symptoms of the disease, and it can go undetected for decades.
World Health Organization notes that two regions of the world have more than 6 percent of their adults populations infected with hepatitis-B: western Pacific at 6.2 percent and Africa with 6.1 percent. Simple screening techniques that detect hepatitis-B antigens are available, but current diagnostic methods to determine extent and progress of the disease are invasive, such as liver biopsies. Or the tests require expensive analytical systems, like DNA analysis, or Fibroscans that use radio waves to measure fibrosis or scarring of the liver.
The team led by Imperial College medical school professor Maud Lemoine is seeking simpler and far less expensive techniques for diagnosing the disease, particularly for low-resource regions where hepatitis-B occurs most often. Lemoine, with colleagues from Pasteur Institute in Paris and the Gambia unit at the London School of Hygiene and Tropical Medicine, investigated indicators of hepatitis-B in blood samples, and calculated diagnostic scores for those individuals. The sampled blood came from donations to blood banks in the Gambia, a country in west Africa, and originally evaluated in a program called Prolifica, short for Prevention of liver fibrosis and cancer in Africa.
The researchers identified tests that can be done on blood samples to detect hepatitis-B antigens and enzymes indicating liver damage without expensive equipment. These blood test measures, combined with demographic factors, were then constructed into a composite score, called Treat-B, characterizing the state of the disease, and indicating the need for further treatment. The team accessed blood samples from 804 individuals taking part in the Prolifica project, to construct the Treat-B scoring technique.
The researchers validated the Treat-B technique with a separate group of 327 individuals infected with hepatitis-B, and at various stage of the disease, in the African countries of Senegal and Burkina Faso, as well as Africans living in the U.K., France, and Germany. The results show Treat-B scores accurately diagnosed the seriousness of an individual’s hepatitis-B 85 percent of the time, indicating the need for treatment, while also accurately indicating the individuals not needing treatment 77 percent of the time.
The researchers say current hepatitis-B diagnostics can cost from $100 to $500, while Treat-B can be administered for about $20 each. While tests with larger samples are still needed, the authors believe the Treat-B process can be designed into a simple finger-prick blood test for use with large populations in Africa and other limited-resource regions.
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