Health-related Quality of Life in Patients With Chronic Hepatitis B and Liver-Related Complications in The Gambia

OBJECTIVES: Health related quality of life (HRQoL) in chronic hepatitis B infection (CHB) is poorly studied in Africa despite the high burden of disease. We aimed to assess HRQoL and health utility (HU) across different stages of infection and liver-related disease in The Gambia, West Africa. METHODS: A cross-sectional study was carried out between January and November 2019. Participants were recruited from outpatient clinics and inpatient wards. Patients were stratified into 5 disease stages CHB not meeting treatment eligibility criteria (CHB-NT), CHB on antiviral treatment (CHB-OT), compensated cirrhosis (CC), decompensated cirrhosis (DC), and hepatocellular carcinoma (HCC). HRQoL was measured using the EuroQol 5-Dimension 3-Level instrument. The main determinants of HRQoL were established and HU by disease stage quantified. RESULTS: A total of 321 participants were included in the final analysis (148 CHB-NT, 41 CHB-OT, 34 CC, 24 DC, and 74 HCC); median age was 38 (IQR 33-45), 80.1% (257/321) were male. Compared with carriers not on treatment, patients with advanced disease (DC and HCC) had significantly lower HU scores (mean reductions of 0.32, [95% CI -0.22 to -0.42]; P < .001 and 0.52, [95% CI -0.45 to -0.58]; P < .001, respectively). The detrimental effect was mediated through an impact on all 5 domains. Additional independent factors impacting HRQoL included the presence of extrahepatic comorbidity, age, and personal monthly income. CONCLUSIONS: Hepatitis B virus and liver-related complications have a significant impact on HRQoL in the Gambia. The sharp decline in HRQoL with advanced stages highlights the importance of improving early diagnosis and expanding access to treatment to prevent disease progression.