I help Africa’s forgotten HBV people

I am part of the Hepatitis B in Africa Collaborative Network (HEPSANET).1 Our mission is to harmonise ongoing baseline and longitudinal data collection, analysis, and dissemination on HBV

infections from more than 13 collaborating cohorts in Burkino Faso, Ethiopia, Gambia, Ghana, Malawi, Nigeria, Senegal, South Africa, Sudan and Zambia, with more countries expected to join.

We call HBV patients the forgotten people2 because the disease disproportionately affects those under-served by health systems. An estimated 80 million people in the WHO Africa region have

chronic HBV infections, often without realising it.

Guidelines developed in Europe or the United States are not appropriate, because patterns of disease in Africa differ. To improve cost-effective treatment in Africa, we developed the

HEPSANET eligibility score.3 It simplifies clinical evaluations and decisions about when to initiate patients on antiviral therapy. We were heartened when a Chinese study in The Lancet

Regional Health4 considered our score for resource-limited parts of the Asia-Pacific region.

I also study Hepatitis E (HEV), a zoonotic infection that spreads mainly through contaminated water or food (often pork). In 2012 I was part of a research group which described the first

chronic HEV infection case in an HIV-infected patient in South Africa. One of my recent Medical Virology postgraduate students, Bronwyn Roberts,5 studied the use of wastewater samples to

track community-level HEV infections.

I learned my way around a medical laboratory in a clinical diagnostic laboratory in Harare, and then at the African Institute of Biomedical Science and Technology, also in Harare.

Two years at the National Referral Laboratory in Mbabane in eSwatini were extremely formative in my development as a biomedical scientist and researcher. In the mid-2000s I was in charge of

putting the necessary laboratory facilities in place so that HIV tests on infants could be performed in Eswatini, rather than at government facilities in South Africa. That’s one of my

proudest achievements. Today I help with the tracking and genomic surveillance of viral hepatitis, SARS-CoV-2, influenza, and other respiratory viruses, through a dual appointment as senior

medical scientist at South Africa’s National Health Laboratory Service in Cape Town and the Division of Medical Virology at Stellenbosch University (SU).

Hepatitis is usually caused by five unrelated hepatotropic viruses (A, B, C, D, or E) that inflame liver tissue. The whites of some patients’ eyes turn yellow. Patients are extremely tired,

vomit and suffer stomach pains. When left untreated or diagnosed too late, cirrhosis or liver cancer can develop among chronic Hepatitis B (HBV) or C patients.

In 2016 I completed my PhD at SU on chronic HBV and its long-term complications. I found that HIV-infected patients present with liver cancer at a much younger age than others. I am most

worried about HBV patients who show no symptoms until the disease is already advanced. I have seen 20-year-olds dying of such cancer. While HBV can be transmitted sexually, timely infant

vaccination is important because most chronic patients are infected in early childhood from their mothers or playmates.