Epidemiology of Acute Liver Failure Attributable To Viral Infections in Sub-Saharan Africa: A Systematic Review

Abstract

Larry N Tangie, Karin E Mba Eya and Brice K Njobe

Viral hepatitis remains the leading cause of acute liver failure (ALF) in Asia and Africa, Sub-Saharan Africa (SSA) inclusive. Data on viral hepatitis-induced ALF is scarce, and systematic screening for rare viral causes is infrequent. This systematic review aims to determine the epidemiological, clinical, therapeutic, and prognostic profiles of viral hepatitis-induced ALF in SSA in the last four decades. We conducted a systematic review using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Records were obtained through an electronic search of MEDLINE (PubMed), EMBASE, SCOPUS, and African Journals Online (AJOL) databases for all relevant studies published from database inception to September 21st, 2023. A total of 16,059 articles were identified from our initial search and 11 studies from 6 countries were included in our final analysis. One hundred and fifty-two cases of viral hepatitis-induced ALF were recorded from 1982- 2022. The most frequent causes were hepatitis A virus (HAV) with 62 cases (40.8%), hepatitis E virus (HEV) with 54 cases (35.5%), and hepatitis B virus (HBV) with 18 cases (11.8%). HAV was the most frequent cause in children, HEV in pregnant women, and HBV and HEV in adults in general. Treatment was mainly supportive and liver transplantation was only reported in studies from South Africa. In the last four decades, HAV has been the leading cause of viral hepatitis-induced ALF in the pediatric population. HEV and HBV account for cases in adults while HEV is frequently reported in pregnant women. Treatment is mainly supportive; liver transplantation is not readily available, and the case fatality rate remains high. These findings highlight the need for implementing routine HAV immunization in expanded programs on immunization available in SSA, especially for children, and routine screening for HEV in pregnant women in HEV endemic zones.

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