Title: Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-
sectional study
Version: 1 Date: 06 Mar 2021
Reviewer's report:
The authors investigated the prevalence of chronic hepatitis B virus (HBV)-infected clinical
phases in 293 Eritrean people using a laboratory-based cross-sectional method, they found
that 273 (93.2%) of the enrolled subjects were HBeAg-negative, and 217 (74.1%) were in the
immune-control phase, 71 (24.2%) were in ‘immune-clearance’ or ‘immune-escape’ phases,
while only 5 (1.7%) of them were eligible for antiviral treatment per the 2018 AASLD HBV
guidance. This is the first study to evaluate the natural history of HBV infection in Eritrea where
a national childhood HBV immunization program was started in 2002. Five patients (1.7%) were
in the immune-tolerant phase and two out of them were younger than 20 years old indicating that
the nationwide HBV vaccination program was successful in this country. This report provided
important information for the healthcare policy body in the country but a few issues still needed
some amendment in its revised version.
1. Reference 2 indicating AASLD 2018 hepatitis B ‘guidance’ instead of ‘guideline’, I
recommend the authors revise the terminology in the manuscript.
2. Since the authors choose the AASLD 2018 hepatitis B guidance, I advise the authors to
follow the diagnostic criteria and definition for chronic hepatitis B which shown in Table 6 of
AASLD 2018 hepatitis B guidance and classifying CHB clinical courses into ‘immune-tolerant’,
‘immune-active’, and ‘inactive CHB’ phases because per the Croagh and Lubel classification
(reference 4), it is too heterogeneous and highly-overlap in ‘immune clearance’, ‘immune
control’, and ‘immune escape’ phases according to the definitions.
3. List the 5 patients’ data who eligible for antiviral treatment per the authors’ recommendation
as one single table.
4. The conclusions stated by the authors were assumption only because we did not see any data
on adopting AASLD treatment guidance with ‘adjustments’ to suit ‘the local setting’ represent
a suitable option in the management of Eritrean CHB patients’.
5. Revise legend for table 1 to ‘Summary of patients’ characteristics by gender’.
6. Polish the language.
Title: Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-
sectional study
Version: 1 Date: 06 Mar 2021
Reviewer's report:
The authors investigated the prevalence of chronic hepatitis B virus (HBV)-infected clinical
phases in 293 Eritrean people using a laboratory-based cross-sectional method, they found
that 273 (93.2%) of the enrolled subjects were HBeAg-negative, and 217 (74.1%) were in the
immune-control phase, 71 (24.2%) were in ‘immune-clearance’ or ‘immune-escape’ phases,
while only 5 (1.7%) of them were eligible for antiviral treatment per the 2018 AASLD HBV
guidance. This is the first study to evaluate the natural history of HBV infection in Eritrea where
a national childhood HBV immunization program was started in 2002. Five patients (1.7%) were
in the immune-tolerant phase and two out of them were younger than 20 years old indicating that
the nationwide HBV vaccination program was successful in this country. This report provided
important information for the healthcare policy body in the country but a few issues still needed
some amendment in its revised version.
1. Reference 2 indicating AASLD 2018 hepatitis B ‘guidance’ instead of ‘guideline’, I
recommend the authors revise the terminology in the manuscript.
2. Since the authors choose the AASLD 2018 hepatitis B guidance, I advise the authors to
follow the diagnostic criteria and definition for chronic hepatitis B which shown in Table 6 of
AASLD 2018 hepatitis B guidance and classifying CHB clinical courses into ‘immune-tolerant’,
‘immune-active’, and ‘inactive CHB’ phases because per the Croagh and Lubel classification
(reference 4), it is too heterogeneous and highly-overlap in ‘immune clearance’, ‘immune
control’, and ‘immune escape’ phases according to the definitions.
3. List the 5 patients’ data who eligible for antiviral treatment per the authors’ recommendation
as one single table.
4. The conclusions stated by the authors were assumption only because we did not see any data
on adopting AASLD treatment guidance with ‘adjustments’ to suit ‘the local setting’ represent
a suitable option in the management of Eritrean CHB patients’.
5. Revise legend for table 1 to ‘Summary of patients’ characteristics by gender’.
6. Polish the language.
Please review this paper.
user
Title: Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-
sectional study
Version: 1 Date: 06 Mar 2021
Reviewer's report:
The authors investigated the prevalence of chronic hepatitis B virus (HBV)-infected clinical
phases in 293 Eritrean people using a laboratory-based cross-sectional method, they found
that 273 (93.2%) of the enrolled subjects were HBeAg-negative, and 217 (74.1%) were in the
immune-control phase, 71 (24.2%) were in ‘immune-clearance’ or ‘immune-escape’ phases,
while only 5 (1.7%) of them were eligible for antiviral treatment per the 2018 AASLD HBV
guidance. This is the first study to evaluate the natural history of HBV infection in Eritrea where
a national childhood HBV immunization program was started in 2002. Five patients (1.7%) were
in the immune-tolerant phase and two out of them were younger than 20 years old indicating that
the nationwide HBV vaccination program was successful in this country. This report provided
important information for the healthcare policy body in the country but a few issues still needed
some amendment in its revised version.
1. Reference 2 indicating AASLD 2018 hepatitis B ‘guidance’ instead of ‘guideline’, I
recommend the authors revise the terminology in the manuscript.
2. Since the authors choose the AASLD 2018 hepatitis B guidance, I advise the authors to
follow the diagnostic criteria and definition for chronic hepatitis B which shown in Table 6 of
AASLD 2018 hepatitis B guidance and classifying CHB clinical courses into ‘immune-tolerant’,
‘immune-active’, and ‘inactive CHB’ phases because per the Croagh and Lubel classification
(reference 4), it is too heterogeneous and highly-overlap in ‘immune clearance’, ‘immune
control’, and ‘immune escape’ phases according to the definitions.
3. List the 5 patients’ data who eligible for antiviral treatment per the authors’ recommendation
as one single table.
4. The conclusions stated by the authors were assumption only because we did not see any data
on adopting AASLD treatment guidance with ‘adjustments’ to suit ‘the local setting’ represent
a suitable option in the management of Eritrean CHB patients’.
5. Revise legend for table 1 to ‘Summary of patients’ characteristics by gender’.
6. Polish the language.
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