Africa Guidelines for Hepatocellular Carcinoma Buildup Process.

PURPOSE: Hepatocellular carcinoma (HCC), the fourth most common cancer in Africa, has a dismal overall survival of only 3 months like in sub-Saharan Africa. This is affected by the low gross domestic product and human development index, absence of coherent guidelines, and other factors. METHODS: An open forum for HCC-experienced health care workers from Africa and the rest of the world was held in October 2021. Participants completed a survey to help assess the real-life access to screening, diagnoses, and treatment in the North and Southern Africa (NS), East and West Africa (EW), Central Africa (C), and the rest of the world. RESULTS: Of 461 participants from all relevant subspecialties, 372 were from Africa. Most African participants provided hepatitis B vaccination and treatment for hepatitis B and C. More than half of the participants use serum alpha-fetoprotein and ultrasound for surveillance. Only 20% reported using image-guided diagnostic liver biopsy. The Barcelona Clinic Liver Cancer is the most used staging system (52%). Liver transplant is available for only 28% of NS and 3% EW. C reported a significantly lower availability of resection. Availability of local therapy ranged from 94% in NS to 62% in C. Sorafenib is the most commonly used systemic therapy (66%). Only 12.9% reported access to other medications including immune checkpoint inhibitors. Besides 42% access to regorafenib in NS, second-line treatments were not provided. CONCLUSION: Similarities and differences in the care for patients with HCC in Africa are reported. This reconfirms the major gaps in access and availability especially in C and marginally less so in EW. This is a call for concerted multidisciplinary efforts to achieve and sustain a reduction in incidence and mortality from HCC in Africa.

Assessment of hepatitis B knowledge and awareness among the Sudanese population in Khartoum State.

Introduction: globally it is estimated that majority of the burden of hepatitis B virus infection is in sub-Saharan African countries (SSA). Africa is also hit by a dreadful complication of hepatocellular carcinoma and sequalae of end-stage liver disease. Despite this, the knowledge and awareness of the population to this silent killer is largely unknown. The aim of this study was to assess the knowledge and awareness of hepatitis B virus among the general population within Sudan to understand the misconceptions and provide a better direction toward the disease elimination goals. Methods: a community-based study was carried out in three locations in Khartoum state during a community hepatitis awareness campaign, where participants were provided education, screening, and vaccine. Data were collected after proper consent was obtained from the respective Institutional Review Board (IRB) office. Basic demographic characteristics, knowledge assessment questions, and awareness were used, which are derived from standard questionnaire. Finally, basic descriptive statistics were undergone to assess the knowledge and awareness of the participants. Results: the study has shown that self-reported hepatitis B among the participants was 9.6%. There are areas of hepatitis B misconception in knowledge and awareness related to transmission, modes of prevention and disease state. We have also noticed that prior vaccine coverage was low among the groups, which is also another major concern. Conclusion: the prevalence of hepatitis B from these randomly selected population groups is high. There is also lower vaccine coverage and many misconceptions in knowledge and awareness of hepatitis B. Policymakers should consider these issues seriously to improve the gaps in hepatitis B.

Helicobacter pylori Infection as a Risk Factor for Hepatocellular Carcinoma: A Case-Control Study in Ethiopia.

Background and Aims. Hepatocellular carcinoma is a major cause of cancer death worldwide, accounting for over half a million deaths per year. Its incidence varies with geographic locations and the type of etiologic factors. In Ethiopia, unidentified causes of liver disease are of sizeable proportion. Recent studies have shown an association of H. pylori infection with different spectrums of chronic liver disease. This study was conducted at St. Paul's Hospital Millennium Medical College in Ethiopia and assesses liver cancer and the association with H. pylori infection. Method. A prospective case-control study conducted on patients with chronic liver disease presenting with a suspicious liver lesion and diagnosed to have HCC in the Gastrointestinal (GI) Clinic of St. Paul's Hospital MMC from Dec 30, 2016, to Nov 1, 2017 G.C. Descriptive surveys on clinical history and physical examination and laboratory profiles were obtained, and the clinical course of the patients including the type of treatment was followed prospectively. Control cases were taken from adult patients without evidence of liver disease in the internal medicine clinic coming for routine evaluation. After collection data were analyzed using SPSS version 23 and associations were assessed using chi-square test. Binary logistic regression was used to assess the association of HCC with different variables and H. pylori infection. All variables with p-value <0.05 were considered as statistically significant. Results. One hundred twenty patients were analyzed with equal representation of cases and controls. The majority of patients with HCC were male with a mean age of 36 years. Older age adjusted Odds Ratio (AOR) (95%CI, p-value) 1.07(1.03-1.09, <0.001), viral hepatitis B (AOR) (95%CI, p-value) 6.19 (1.92-19.93, 0.002), and H. pylori infection (AOR) (95%CI, p-value) 5.22 (2.04-13.31, <0.001) were statistically significantly associated with HCC. Conclusion. H. pylori infection is associated with HCC in this case-control study. This study supports the emerging evidence of H. pylori association with other extra-gastric manifestations.

MAJOR RISK FACTORS, CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS WITH HEPATOCELLULAR CARCINOMA; A RETROSPECTIVE STUDY AT TIKUR ANBASSA HOSPITAL, ADDIS ABABA UNIVERSITY, ADDIS ABABA, ETHIOPIA.

BACKGROUND: Hepatocellular carcinoma (HCC) is a major cause of cancer death worldwide accounting for over half a million deaths per year. Hepatocellular carcinoma can occur secondary to viral hepatitis, HBV or HCV. It can also occur secondary to other causes of Cirrhosis (alcoholism being the other most common cause). OBJECTIVES: To describe clinical and laboratory characteristics of Hepatocellular carcinoma in a tertiary care hospital in Addis Ababa, Ethiopia. METHODS: A retrospective study was conducted in patients admitted to Tikur Anbassa specialized Hospital with a diagnosis of Hepatocellular carcinoma during the period of January 1, 2013 to Dec. 31, 2015. Data were collected using structured questionnaire on basic demographic factors, behavioral risks, laboratory profiles and imaging reports. Descriptive analysis was performed on the data collected. RESULTS: Fifty one patients fulfilled the criteria for Hepatocellular carcinoma in the study period. Thirty nine were males and 12 were females. Hepatitis B and C viruses were found to be the causes for HCC in 48% of the cases. History of alcohol abuse was documented in 45% % of the individuals. About 26% of the patients had Ascites, 35% were found to have portal vein thrombosis, The child-Pugh score for patients who had complete profile were Child A 46%, Child B an equal percentage of 46% andfor Child C 0.7%. CONCLUSION: The contribution of Hepatitis virus is high with equivalent proportion of HBV and HCV. Alcohol intake and unidentified risk factors have also played for another half of the causes. Almost a third of patients have Portal vein thrombosis and 96% were either Child Pugh A or B. Enhancing immunization coverage frequent use of infection prevention and availability of treatment for viral hepatitis will help to reduce Hepatocellular carcinoma.