Cirrhosis and Liver Cancer in West Africa: Focus on Use of Tenofovir Disoproxil Fumarate

By: Victoria Kuhr, MS
Posted: Wednesday, September 13, 2023

Maud Lemoine, PhD, of St. Mary’s Hospital, London, and colleagues conducted a prospective cohort study of more than 300 patients with either hepatocellular carcinoma or cirrhosis in The Gambia, West Africa. In sub-Saharan Africa, chronic liver disease has been a major cause of premature death. However, the investigators found that use of the antiretroviral agent tenofovir disoproxil fumarate (TDF)—a prodrug of tenofovir—was effective in reducing the rates of premature mortality in patients with cirrhosis and hepatitis B virus (HBV) infection. These findings were published in The Lancet Global Health.

“Interventions for early diagnosis and treatment of cirrhosis as well as screening programs for hepatocellular carcinoma are urgently required in Africa,” said the study authors.

Of the 529 patients enrolled in the study, 252 were diagnosed with hepatocellular carcinoma and 84 were diagnosed with cirrhosis between 2012 and 2105 in The Gambia. The median patient age was 42 years. Overall, 84% of patients with data tested positive for HBV biomarkers, 10% tested positive for hepatitis C virus antibodies, and 10% tested positive for hepatitis D virus antibodies. Patients who were diagnosed with chronic HBV infections and cirrhosis, without hepatocellular carcinoma, were offered TDF. Additionally, 64% of patients with hepatocellular carcinoma had multifocal tumors, with a median tumor size of 7.5 cm.

A total of 243 patients (173 with hepatocellular carcinoma and 70 with cirrhosis) were included in the survival analysis. The median survival time was 1.5 months in those with liver cancer and 17.1 months in those with cirrhosis (P < .0001). Researchers found that ascites, partial or complete portal thrombosis, and platelet count were independent predictive factors of mortality at baseline for patients with hepatocellular carcinoma. In patients with HBV and cirrhosis, the median turnaround time between cirrhosis diagnosis and TDF initiation was 4.9 months. Additionally, TDF treatment was associated with improved survival in patients with HBV-related cirrhosis (P < .0001).

Disclosure: For full disclosures of the study authors, visit thelancet.com.

The Lancet Global Health

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