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Fighting liver cancer in West Africa

Chronic hepatitis B virus (HBV) infection is the main cause of hepatocellular carcinoma (HCC), a form of liver cancer, in Africa. A large-scale study aimed to improve the control of HBV in West Africa (WA), using a screen and treat strategy to reduce the incidence of HCC.
Fighting liver cancer in West Africa
HCC is the most common cause of cancer death in adult males in Africa and the peak incidence of this cancer is between the ages of 30 and 50. HBV infection is responsible for 60 – 80% of liver cancers. HBV affects 250 million people worldwide and the prevalence of infection is particularly high in sub-Saharan Africa. The EU-funded project PROLIFICA (Prevention of liver fibrosis and cancer in Africa) explored the factors responsible for the development of HCC and public health strategies to reduce the number of deaths.

The objectives of PROLIFICA included early detection and treatment of HBV and evaluation of whether it can result in a reduction of HCC development. Ultrasound detection of early, treatable tumours is part of the project.

The study involved patients from Gambia, Nigeria and Senegal. The project used biological samples for proteomic, metabonomic and genomic analyses to identify biomarkers for HCC. They developed valuable simple HCC diagnostic tools and evaluated selective antiviral therapy for HCC prevention.

The WA treatment cohort (WATCH) and the HCC case-control studies screened and recruited more than 10 000 patients. All clinical, laboratory and epidemiological data were collected in a database for further analysis.

Researchers used biological samples to perform metabonomic analysis and identify potential liver cancer biomarkers. Biomarkers from both urine and sera samples were used to screen for and specifically diagnose HCC. A prototype point-of-care diagnostic system was tested for immunodetection of HCC.

For HBV viral load determination, a quantitative polymerase chain reaction assay was established. European partners provided ultrasound and liver biopsy equipment for clinical diagnosis of liver cancer in Gambia and Senegal. WA partners were trained in histopathology to confirm clinical liver cancer diagnosis and determine its stages.

The WATCH study data was used to populate a simulation model of the global HBV epidemic to estimate the potential impact of public health interventions. The model demonstrated that HBV/HCC mortality cannot be controlled without using the screen and treat strategy outlined in the WATCH study.

PROLIFICA has demonstrated that screening and treatment for HBV in WA is feasible and cost effective. Their work highlighted that this screen and treat strategy is an essential component of any public health intervention to effectively contain this infection.

Related information

Keywords

Hepatitis B virus, hepatocellular carcinoma, West Africa, PROLIFICA, HCC biomarkers
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