Eligibility for hepatitis B virus (HBV) treatment and prevalence of drug resistance in a Ugandan population cohort
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The World Health Organization (WHO) 2024 Hepatitis B virus (HBV) treatment guidelines expand eligibility for nucleos(t)ide analogue treatment in individuals with chronic HBV infection. For countries to implement these guidelines, there is a critical need to understand the population who are treatment eligible. While HBV drug resistance (HBVDR) is uncommon, monitoring for any potential resistance is a relevant public health consideration. METHODS: We studied a population in rural Uganda to describe the proportion of individuals eligible for treatment based on the 2024 WHO treatment guidelines. We determined how this proportion varies according to the eligibility criteria used, comparing the performance of different assessment tools. We calculated Aspartate Aminotransferase-to-Platelet Ratio Index; APRI, Gamma-Glutamyl Transpeptidase-to-Platelet Ratio; GPR and transient elastography; TE and performed HBV sequencing using Oxford Nanopore Technology to determine the prevalence of HBVDR in treatment naive and treatment experienced individuals. RESULTS: In this cohort, 24/63 (38%) individuals with CHB were eligible for treatment. This fell to 14/63 (22%) in a hypothetical scenario where TE was not available for the assessment of liver fibrosis. We demonstrate a lack of concordance between non-invasive tests (NIT) of liver disease in treatment-naive HBV mono-infected individuals. An APRI cut-off of 0.5 had a sensitivity of 23.0% for predicting a TE score of >7 kPa (F2 fibrosis). Sensitivity for detecting F2 fibrosis was increased to 38.5% using an APRI cut off of 0.36, and to 46.2% using the GPR. We did not identify any HBVDR in the HBV mono-infected treatment-naive population (n=58). 24/210 individuals were living with HIV/HBV coinfection; HBV was sequenced in 5 of these of whom 2 had genomic evidence of nucleos(t)ide analogue resistance (rt180M/204V). CONCLUSIONS: While the WHO 2024 treatment criteria offer an opportunity to expand access to care, there is a need to determine how assessment tools differ in determination of eligibility in different settings. HBVDR remains uncommon but more research is needed to understand its prevalence and clinical impact in African populations.
Source: Journal of Infection
Authors: Sheila F. Lumley, Beatrice Kimono, Joseph Mugisha, Ronald Makanga, Moses Kwizera Mbonye, Kevin Ojambo, Elizabeth Waddilove, Chris Kent, Brian Ssengendo, Richard Ndungutse, Anna L. McNaughton, Florence Nambaziira Muzaale, Janet Seeley, Josh Quick, Ponsiano Ocama, Robert Newton, Philippa C. Matthews
Institutions: University of Oxford, Medawar Building for Pathogen Research, Oxford University Hospitals NHS Trust, MRC/UVRI & LSHTM Uganda Research Unit, Uganda Virus Research Institute, The Francis Crick Institute, University of Birmingham, University of Bristol, London School of Hygiene & Tropical Medicine, Makerere University, University of York, University College London Hospitals NHS Foundation Trust, University College London
Language: English
Topic: Hepatitis B Virus Studies
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,030
Funders: London School of Hygiene and Tropical Medicine, Wellcome Trust, Francis Crick Institute, National Institute for Health and Care Research, University College London, University of Oxford, NIHR Maudsley Biomedical Research Centre, Medical Research Council, John Fell Fund, University of Oxford, UCLH Biomedical Research Centre
OpenAlex ID: W7119138564