Liver cirrhosis and hepatocellular carcinoma attributable to hepatitis B and C in Kyrgyzstan, 2019–2024: a prospective and retrospective study

Background: Hepatitis B, C, and D viruses (HBV/HCV/HDV) can cause chronic infections that lead to sequelae like liver cirrhosis and hepatocellular carcinoma (HCC). We aimed to estimate the fractions of cirrhosis and HCC attributable to HBV and HCV in Kyrgyzstan. Methods: We collected information on patients diagnosed with cirrhosis and/or HCC from medical records in clinical hospitals and oncology centres in Bishkek, Osh, and Jalalabad. The study included a prospective part from 08/2023 to 04/2024 and a retrospective part from 01/2019 to 07/2023. We calculated attributable fractions (AFs) with 95% confidence intervals (95% CI) for HBV and HCV and stratified results by age, sex, and region. We analysed test results for HBV surface antigen (HBsAg), antibodies to HCV (anti-HCV) and HDV (anti-HDV), and viral DNA/RNA. Findings: Among participants with cirrhosis, we found AFs of 46% (95% CI 42-49%) for HBV (416/914) and 25% (95% CI 22-28%) for HCV (226/914). Among participants with HCC, AFs to HBV (182/572) and HCV (183/572) were both 32% (95% CI 28-36%). These calculations included 3% of cirrhosis (25/914) and HCC (17/572) patients who had HBV/HCV-coinfections. Among participants tested for anti-HDV, 78% (306/390) of cirrhosis patients and 50% (44/88) of HCC patients tested positive [for anti-HDV]. Interpretation: Large fractions of cirrhosis and HCC cases were attributable to HBV and HCV, with HBV/HDV-coinfections being common. To prevent long-term sequelae and to eliminate viral hepatitis as a public health threat in Kyrgyzstan, earlier testing and treatment options should be implemented. Funding: This study received financial support in the framework of the Global Health Protection Programme by the Federal Government of Germany.