Title: Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with
Hepatitis B virus infection in Freetown, Sierra Leone: A cross-sectional study
Version: 2 Date: 28 Apr 2021
Reviewer's report:
This study tackles an important issue related to HBV which evaluates the clinical presentation
and patterns of HBV serum markers in asymptomatic patients. However, the sample size was
small.
My comments are:
1. The following statement all through the manuscript very confusing "the presence of any
symptom strongly predicted the presence of significant liver fibrosis" however regression
analysis in the study predict liver cirrhosis (cutoff of APRI above 2 and FIB-4 above 3.25), not
significant fibrosis. Please clarify and correct all through the manuscript.
2. Mention inclusion and exclusion criteria of the study.
3. The five patients with HIV/HBV co-infection and the one patient with HCV/HBV co-
infection. I think they should be excluded from the study to ensure homogeneity of the study
population as co-infection affects the natural history of disease and it is difficult to compare
them with patients with HBV mono-infection due to their relatively small number.
4. The author mentioned 4 patients had features suggestive of a hepatoma. Data of confirmation
of HCC as AFP and CT should be added as HBV is an established hepatocarcinogen.  Also,
these patients had HBV mono-infection or co-infection.
5. The following statement needs a good and clear interpretation in the result section " Although
most of the patients were asymptomatic, where any symptom was present, the patient was
already more likely to have a non-invasive marker likelihood of liver fibrosis based on APRI
scores"
Title: Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with
Hepatitis B virus infection in Freetown, Sierra Leone: A cross-sectional study
Version: 2 Date: 28 Apr 2021
Reviewer's report:
This study tackles an important issue related to HBV which evaluates the clinical presentation
and patterns of HBV serum markers in asymptomatic patients. However, the sample size was
small.
My comments are:
1. The following statement all through the manuscript very confusing "the presence of any
symptom strongly predicted the presence of significant liver fibrosis" however regression
analysis in the study predict liver cirrhosis (cutoff of APRI above 2 and FIB-4 above 3.25), not
significant fibrosis. Please clarify and correct all through the manuscript.
2. Mention inclusion and exclusion criteria of the study.
3. The five patients with HIV/HBV co-infection and the one patient with HCV/HBV co-
infection. I think they should be excluded from the study to ensure homogeneity of the study
population as co-infection affects the natural history of disease and it is difficult to compare
them with patients with HBV mono-infection due to their relatively small number.
4. The author mentioned 4 patients had features suggestive of a hepatoma. Data of confirmation
of HCC as AFP and CT should be added as HBV is an established hepatocarcinogen.  Also,
these patients had HBV mono-infection or co-infection.
5. The following statement needs a good and clear interpretation in the result section " Although
most of the patients were asymptomatic, where any symptom was present, the patient was
already more likely to have a non-invasive marker likelihood of liver fibrosis based on APRI
scores"
Please review this paper.
user
Title: Prevalence of sero-markers and non-invasive assessment of liver cirrhosis in patients with
Hepatitis B virus infection in Freetown, Sierra Leone: A cross-sectional study
Version: 2 Date: 28 Apr 2021
Reviewer's report:
This study tackles an important issue related to HBV which evaluates the clinical presentation
and patterns of HBV serum markers in asymptomatic patients. However, the sample size was
small.
My comments are:
1. The following statement all through the manuscript very confusing "the presence of any
symptom strongly predicted the presence of significant liver fibrosis" however regression
analysis in the study predict liver cirrhosis (cutoff of APRI above 2 and FIB-4 above 3.25), not
significant fibrosis. Please clarify and correct all through the manuscript.
2. Mention inclusion and exclusion criteria of the study.
3. The five patients with HIV/HBV co-infection and the one patient with HCV/HBV co-
infection. I think they should be excluded from the study to ensure homogeneity of the study
population as co-infection affects the natural history of disease and it is difficult to compare
them with patients with HBV mono-infection due to their relatively small number.
4. The author mentioned 4 patients had features suggestive of a hepatoma. Data of confirmation
of HCC as AFP and CT should be added as HBV is an established hepatocarcinogen.  Also,
these patients had HBV mono-infection or co-infection.
5. The following statement needs a good and clear interpretation in the result section " Although
most of the patients were asymptomatic, where any symptom was present, the patient was
already more likely to have a non-invasive marker likelihood of liver fibrosis based on APRI
scores"
assistant