Mary Duguru

University of Jos

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Edith Okeke

Jos University Teaching Hospital

Pantong Davwar

Jos University Teaching Hospital

Lewis R. Roberts

Mayo Clinic in Arizona

Atiene S. Sagay

Jos University Teaching Hospital

Claudia Hawkins

Northwestern University

Abraham O. Malu

Benue State University

Emuobor Odeghe

University of Lagos

Godwin Imade

Jos University Teaching Hospital

Olufunmilayo Lesi

University of Lagos

Maud Lemoine

St Mary's Hospital

Cooperative Institutions

Jos University Teaching Hospital

University of Jos

Northwestern University

Imperial College London

Midwestern University

University of Lagos

University Teaching Hospital

Lagos University Teaching Hospital

Northwest University

Lagos State University Teaching Hospital

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Discovery and validation of urinary metabotypes for the diagnosis of hepatocellular carcinoma in West Africans

Hepatology (2014)

Nimzing G. Ladep Anthony C. Dona Matthew R. Lewis Mary M.E. Crossey Maud Lemoine

There is no clinically applicable biomarker for surveillance of hepatocellular carcinoma (HCC), because the sensitivity of serum alpha-fetoprotein (AFP) is too low for this purpose. Here, we determined the diagnostic performance of a panel of urinary metabolites of HCC patients from West Africa. Urine samples were collected from Nigerian and Gambian patients recruited on the case-control platform of the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) program. Urinary proton nuclear magnetic resonance ((1) H-NMR) spectroscopy was used to metabolically phenotype 290 subjects: 63 with HCC; 32 with cirrhosis (Cir); 107 with noncirrhotic liver disease (DC); and 88 normal control (NC) healthy volunteers. Urine samples from a further cohort of 463 subjects (141 HCC, 56 Cir, 178 DC, and 88 NC) were analyzed, the results of which validated the initial cohort. The urinary metabotype of patients with HCC was distinct from those with Cir, DC, and NC with areas under the receiver operating characteristic (AUROC) curves of 0.86 (0.78-0.94), 0.93 (0.89-0.97), and 0.89 (0.80-0.98) in the training set and 0.81 (0.73-0.89), 0.96 (0.94-0.99), and 0.90 (0.85-0.96), respectively, in the validation cohort. A urinary metabolite panel, comprising inosine, indole-3-acetate, galactose, and an N-acetylated amino acid (NAA), showed a high sensitivity (86.9% [75.8-94.2]) and specificity (90.3% [74.2-98.0]) in the discrimination of HCC from cirrhosis, a finding that was corroborated in a validation cohort (AUROC: urinary panel = 0.72; AFP = 0.58). Metabolites that were significantly increased in urine of HCC patients, and which correlated with clinical stage of HCC, were NAA, dimethylglycine, 1-methylnicotinamide, methionine, acetylcarnitine, 2-oxoglutarate, choline, and creatine. The urinary metabotyping of this West African cohort identified and validated a metabolite panel that diagnostically outperforms serum AFP.

10.1002/hep.27264

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Citations (73)

P423 FACTORS IN THE MORTALITY OF NEWLY DIAGNOSED HCC PATIENTS IN NIGERIA

Journal of Hepatology (2014)

E. Okeke Nimzing G. Ladep Pantong Davwar Mary Duguru Edmund Banwat

10.1016/s0168-8278(14)60585-7

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Citations (2)

Childhood Sleep Disordered Breathing: Epidemiology, Health Implications and Surgical Management in Jos, Nigeria.

Zenodo (CERN European Organization for Nuclear Research) (2023)

Daniel D. Kokong F A Obebe Mary Duguru JO Edah Christopher Goson Piwuna

Sleep-Disordered Breathing

10.5281/zenodo.7633956

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Citations (0)

Development and evaluation of a simple treatment eligibility score (HEPSANET) to decentralise hepatitis B care in Africa: a cross-sectional study

The Lancet. Gastroenterology & hepatology (2024)

Nicolas Minier Alice Nanelin Guingané Edith Okeke Edford Sinkala Asgeir Johannessen

Cross-sectional study

10.1016/s2468-1253(23)00449-1

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Citations (9)

Systematic review and individual-patient-data meta-analysis of non-invasive fibrosis markers for chronic hepatitis B in Africa

Nature Communications (2023)

Asgeir Johannessen Alexander Stockdale Marc Henrion Edith Okeke Moussa Seydi

Abstract In sub-Saharan Africa, simple biomarkers of liver fibrosis are needed to scale-up hepatitis B treatment. We conducted an individual participant data meta-analysis of 3,548 chronic hepatitis B patients living in eight sub-Saharan African countries to assess the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index and two other fibrosis biomarkers using a Bayesian bivariate model. Transient elastography was used as a reference test with liver stiffness measurement thresholds at 7.9 and 12.2kPa indicating significant fibrosis and cirrhosis, respectively. At the World Health Organization-recommended cirrhosis threshold (>2.0), aspartate aminotransferase-to-platelet ratio index had sensitivity (95% credible interval) of only 16.5% (12.5–20.5). We identified an optimised aspartate aminotransferase-to-platelet ratio index rule-in threshold (>0.65) for liver stiffness measurement >12.2kPa with sensitivity and specificity of 56.2% (50.5–62.2) and 90.0% (89.0–91.0), and an optimised rule-out threshold (<0.36) with sensitivity and specificity of 80.6% (76.1–85.1) and 64.3% (62.8–65.8). Here we show that the World Health Organization-recommended aspartate aminotransferase-to-platelet ratio index threshold is inappropriately high in sub-Saharan Africa; improved rule-in and rule-out thresholds can optimise treatment recommendations in this setting.

Transient elastography

Hepatitis B

Hepatitis C

10.1038/s41467-022-35729-w

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Citations (27)

Hepatocellular Carcinoma Occurs at an Earlier Age in Africans, Particularly in Association With Chronic Hepatitis B

The American Journal of Gastroenterology (2015)

Ju Dong Yang Adam Gyedu Mary Afihene Babatunde Duduyemi Eileen Micah

Yang, Ju Dong MD, MSc; Gyedu, Adam MD, MPH; Afihene, Mary Yeboah MB ChB; Duduyemi, Babatunde M MB ChB; Micah, Eileen MB ChB; Kingham, Peter T MD; Nyirenda, Mulinda MD; Nkansah, Adwoa Agyei MB ChB; Bandoh, Salome MB ChB; Duguru, Mary J MD; Okeke, Edith N BM BCh; Kouakou-Lohoues, Marie-Jeanne MD; Abdo, Abdelmounem MD; Awuku, Yaw Asante MD; Ajayi, Akande Oladimeji MD; Omonisi, Abidemi Emmanuel MD; Ocama, Ponsiano MB ChB, MMED, PhD; Malu, Abraham O MD; Mustapha, Shettima MD; Okonkwo, Uchenna MD; Kooffreh-Ada, Mbang MD; Debes, Jose D MD; Onyekwere, Charles MD; Ekere, Francis MD; Rufina, Igetei MD; Roberts, Lewis R MB ChB, PhD the Africa Network for Gastrointestinal and Liver Diseases Author Information

Association (psychology)

Hepatitis B

10.1038/ajg.2015.289

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Citations (79)

Hepatocellular carcinoma presentation and prognosis among Nigerian adults with and without HIV

PLoS ONE (2023)

Pantong Davwar Edith Okeke Mary Duguru David Nyam Kristen Bell

Hepatocellular carcinoma (HCC) is an increasing cause of mortality in Nigeria among persons with HIV (PLH), as access to antiretroviral therapy (ART) improves. In this study we describe clinical, radiological, and laboratory characteristics in Nigerian adults with HCC, with and without HIV, and examine how HIV impacts survival.This prospective observational study was conducted between August 2018 and November 2021 at two Nigerian hospitals [Jos University Teaching Hospital (JUTH) and Lagos University Teaching Hospital (LUTH)]. Subjects ≥18 years with HCC diagnosed according to American Association for the Study of Liver Diseases (AASLD) criteria were included. Baseline characteristics were compared, and Kaplan-Meier curves were generated to estimate survival.213 subjects [177 (83%) without HIV and 36 (17%) with HIV (PLH)] were enrolled. Median age was 52 years (IQR 42,60) and most subjects were male (71%). 83% PLH were on antiretroviral therapy (ART). Hepatitis B surface antigen (HBsAg) positivity was similar between the two groups [91/177 (51%) without HIV vs. 18/36 (50%) with HIV; p = 0.86]. 46/213 (22%) subjects had active hepatitis C (anti-HCV+/HCV RNA>10 IU/mL). Cirrhosis was more common in PLH but there were no other significant differences in clinical and tumor characteristics between the groups. Overall, 99% subjects were symptomatic and 78% in late-stage HCC. Median overall survival was significantly shorter in PLH vs. without HIV (0.98 months vs 3.02 months, HR = 1.55, 95%CI 1.02, 2.37, p = 0.04). This association was not significant after adjusting for known risk factors including gender, current alcohol use, alpha-fetoprotein (AFP), albumin, and total bilirubin (HR = 1.38, 95%CI 0.84, 2.29, p = 0.21).HCC presented late with an extremely poor overall prognosis, highlighting the urgent need for more intensive surveillance in Nigeria to diagnose HCC at earlier stages. Early diagnosis and management of viral hepatitis, and access to HCC therapies, could prevent early mortality among persons with HCC, especially among PLH.

Presentation (obstetrics)

10.1371/journal.pone.0282539

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Citations (9)

Hepatitis B and C Virus Co-Infection and Their Association With Liver Disease in Persons With HIV in Nigeria

Journal of the International Association of Providers of AIDS Care (JIAPAC) (2024)

Emuobor Odeghe Ganiyat K. Oyeleke Mayowa O. Odofin Mary Duguru Pantong Davwar

Background: The burden of chronic viral hepatitis among people living with human immunodeficiency virus (PLWH) and its association with liver disease in Nigeria has been seldom explored. Our objective was to compare characteristics in PLWH with and without significant liver fibrosis/cirrhosis, examining its association with viral hepatitis and other risk factors. Methods: Cross-sectional study among PLWH with and without significant fibrosis/cirrhosis (transient elastography ≥ 9.3 kPa) between July 2018 and August 2022. Data were compared between participant groups and logistic regression used to determine association between chronic viral hepatitis and significant fibrosis/cirrhosis. Results: Five hundred and thirty-seven participants (34.3% male), median age 46 years, 22.2% with significant fibrosis/cirrhosis were analyzed. Seroprevalence of hepatitis B virus (HBV) was 11.2% and hepatitis C virus (HCV) 5.7%. Male sex, diabetes, HBV, and HCV were associated with significant fibrosis/cirrhosis, while ART for >5 years was associated with reduced risk. Conclusion: The chronic hepatitis viruses are associated with significant liver fibrosis/cirrhosis in PLWH in Nigeria, highlighting the importance of viral hepatitis awareness, screening, and treatment in HIV programs to reduce the risk of liver disease. Plain Language Summary Hepatitis B and C infection and liver disease in people with HIV infection in Nigeria People living with human immunodeficiency virus (HIV) infection who have hepatitis B or C infection have a higher chance of developing advanced liver disease than those who do not have either of the hepatitis infections. This finding highlights the importance of awareness, screening, and treatment of the hepatitis viruses in HIV programs in order to reduce the risk of liver disease in this population.

Liver disease

Hepatitis C

Hepatitis B

Viral Hepatitis

Transient elastography

10.1177/23259582241292511

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Citations (0)

Mo1510 Prognosis of Patients With Hepatocellular Carcinoma Is Extremely Poor in African Country

Gastroenterology (2016)

Ju Dong Yang Edith Okeke Mary Duguru Mary Afihene Babatunde Duduyemi

10.1016/s0016-5085(16)33832-x

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Epidemiology of Liver Cancer in Africa: Current and Future Trends

Seminars in Liver Disease (2019)

Edith Okeke Pantong Davwar Lewis R. Roberts Kurt Sartorius W. Spearman

Abstract Hepatocellular carcinoma (HCC) is a disease of global public health significance with mortality on the rise, despite the preventable nature of its risk factors especially in Africa. It is now the sixth most common cancer worldwide, fifth in males, and ninth in females. HCC incidence and mortality are predicted to increase in African countries constrained by limited resources to combat endemic levels of viral infection and synergistic environmental risk factors. The changing nature of HCC etiology is particularly illustrated here with the traditional risk factors like viral hepatitis coexisting alongside high human immunodeficiency virus (HIV) prevalence and rapidly increasing urbanization that have promoted a sharp increase in additional risk factors like coinfection, type 2 diabetes mellitus, and obesity. Although there are some differences in etiology between North Africa and sub-Saharan Africa, risk factors like chronic viral hepatitis B and C, aflatoxin exposure, and iron overload predominate. Aggressive hepatitis B genotypes, combined with hepatitis B virus/hepatitis C virus/HIV coinfections and aflatoxin exposure, promote a more aggressive molecular phenotype. In parallel to a better understanding of the molecular etiology of HCC, policy and planning initiatives to address the burden of HCC must be anchored within the reality of the limited resources available. Establishment and coordination of cancer registries across Africa is needed to improve the quality of data necessary to galvanize action. Preventive measures including hepatitis B vaccination programs, measures to prevent maternal-to-child and child-to-child transmission, delivery of universally accessible antiretroviral and antiviral treatments, and reduction of dietary aflatoxin exposure can contribute markedly to reduce HCC incidence. Finally, the development of biomarkers and new therapeutic interventions will need a better understanding of the unique genetic and epigenetic characteristics of HCC on the continent. We present a narrative review of HCC in Africa, discussing present and future trends.

Hepatitis B

Viral Hepatitis

Hepatitis C

Liver Cancer

10.1055/s-0039-3399566

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Citations (50)