Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Acute Liver Failure Attributable to Viral Infections in Sub-Saharan Africa: A Narrative Review

Version 1 : Received: 28 April 2023 / Approved: 3 May 2023 / Online: 3 May 2023 (12:40:38 CEST)

How to cite: Tangie, L.N.; Njobe, B.; Essouma, M. Acute Liver Failure Attributable to Viral Infections in Sub-Saharan Africa: A Narrative Review. Preprints 2023, 2023050149. https://doi.org/10.20944/preprints202305.0149.v1 Tangie, L.N.; Njobe, B.; Essouma, M. Acute Liver Failure Attributable to Viral Infections in Sub-Saharan Africa: A Narrative Review. Preprints 2023, 2023050149. https://doi.org/10.20944/preprints202305.0149.v1

Abstract

Though there has been a decline in the number of new cases of viral hepatitis-induced acute liver failure in Europe and the United States of America, viral hepatitis still remains the leading cause of acute liver failure in Asia-Pacific and South America. However, the epidemiology of viral-hepatitis-induced acute liver failure in sub-Saharan Africa-the world epicenter of viral hepatitis-is unclear. The aim of this review was to collate data on the incidence, prevalence, specific etiologic agents, features/diagnosis, treatment and prognosis of viral-induced acute liver failure in sub-Saharan Africa. One hundred and forty-seven cases of viral-induced acute liver failure were recorded in 11 studies conducted in six countries between 1981-2020. Etiological agents were: Hepatitis viruses A, B, C, and E, as well as Adenovirus, Enterovirus, Parvovirus, Herpes Simplex Virus (HSV) and EBV. HAV was the most frequent in paediatric subjects: (11/16) 69% and (19/30) 63%. HBV was the only etiological agent in the study that only included adults. HEV (genotype 2 in one study) contracted amidst hepatitis E outbreaks was the most commonly reported cause of ALF in pregnant women. Treatment was mainly supportive, and liver transplantation reported only in South Africa. Where reported, case fatality rates were high. In conclusion, viral-hepatitis induced acute liver failure is largely understudied in sub-Saharan Africa. The few available data are consistent with literature from the other parts of the world regarding aetiologic agents. Liver transplantation is not available in most sub-Saharan African countries, and short-term case fatality rates of individuals with acute liver failure could outstrip current rates from the other world regions.

Keywords

Acute liver failure; viral hepatitis; sub-Saharan Africa

Subject

Public Health and Healthcare, Public Health and Health Services

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