Clinical utility of TREAT-B score in African and non-African HBV-infected patients living in Europe.

Abstract

In light of global socio-political and economic changes, Europe has once more become a target destination for migrants and refugees from many parts of the world, especially from Africa and the Middle East, the regions worst affected by the hepatitis B epidemic. European countries need to adapt to these sociodemographic changes and develop appropriate strategies in order to target these populations to achieve HBV elimination. The criteria to indicate antiviral treatment eligibility for chronic hepatitis B (CHB) rely on combinations of several tests; these tests are not only expensive (e.g. reverse transcription PCR [RT-PCR] to measure HBV DNA levels) but also require repeated clinical appointments and blood tests. Such clinical algorithms might be difficult to apply in migrant populations, especially in undocumented migrants, where retention in care is poor and the risk of treatment failure is increased. Moreover, in highincome European countries, resources dedicated to healthcare are not infinite and have become seriously restricted over the last few years. As a result, simplified hepatitis B algorithms based on inexpensive diagnostic tools developed in resourcelimited regions might also benefit European countries. Using the large PROLIFICA (Prevention of Liver Fibrosis and Cancer in Africa) cohort of patients with CHB in The Gambia, West Africa, our group recently developed a simple score free from HBV DNA (TREAT-B) indicating antiviral treatment eligibility based solely on alanine aminotransferase (ALT) level and hepatitis B e antigen (HBeAg) sero-status. TREAT-B may be useful as an alternative to the current European guidelines for a simplified identification of patients in need of HBV antiviral therapy. In a training and validation set of African patients (n = 1,131), the score had excellent performance, even higher than the World Health Organization (WHO) criteria without HBV DNA. We believe that this score can help save resources