Liver fibrosis and its associations among people with hepatitis B in rural Uganda: A retrospective records review

Abstract

Introduction: Chronic hepatitis B affects about 240 million people worldwide, with significant complications including liver fibrosis and hepatocellular carcinoma. We aimed to study the prevalence of liver fibrosis and its associations among people with hepatitis B at Mbarara Regional Referral Hospital (MRRH). 

Method: This study was a retrospective review of cross-sectionally collected data in an integrated hospital management system from July 2018 to August 2021 at MRRH. Socio-demographics, co-morbidities, and laboratory parameters were retrieved. Liver fibrosis was defined by an aspartate aminotransferase-to-platelet index score of >2. A bivariable and multivariable logistic regression analysis was used to identify factors associated with liver fibrosis. Associations in the multivariate model with a p-value ≤0.05 were considered statistically significant. 

Results: Five hundred and thirty-seven records of hepatitis B patients were retrieved. The median age was 34 (Interquartile Range (IQR), 28-43) years, and 334 (62.2%) were males. One hundred and two (18.99 %) were alcohol consumers, and 189 (35.20 %) were cigarette smokers at the data collection time. The prevalence of liver fibrosis was 10.8% (CI: 8.4–13.7). Hepatitis B viral load ≥ 20,000 IU/ml (AOR: 3.58; 95% CI:1.2-1.1; p<0.016) and cigarette smokers (AOR: 5.33; 95% CI:1.4-19.9; p<0.013) were independently associated with liver fibrosis. 

Conclusion: At our clinic, one in ten people with hepatitis B infection has liver fibrosis. We recommend regular screening of liver fibrosis in all people with hepatitis B, especially those with a viral load ≥20,000 IU/ml and cigarette smokers. Liver screening by a FibroScan in the hepatitis B prevalent areas of resource-limited settings may improve the detection rate.