Introduction: Long-term follow-up of patients with chronic hepatitis B is sometimes difficult in our context, because it is costly and results in many lost to follow-up. The development of hepatocellular carcinoma (HCC) risk scores could make it possible to identify high-risk patients for optimal follow-up.
Patients and methods: This is a descriptive and analytical retrospective cohort study from January 2014 to December 2022 (9 years) that took place in 2 health facilities in Ouagadougou. It concerned the files of patients with chronic HBV carriers, without viral co-infection, without cirrhotic decompensation or HCC at baseline and who had a clinical follow-up of at least 12 months. The REACH-B and PAGE-B scores assessed the risk of HCC occurring in untreated patients at 3, 5, 10 years of age and in treated patients at 5 and 10 years respectively. Univariate and multivariate logistic regression was used to identify factors associated with the risk of HCC occurrence.
Résultats: A total of 292 patients were included during a mean follow-up of 58 months. The majority of patients, 131 (55.13%) were male with a mean age of 34 years. A family history of cirrhosis and primary liver cancer was found in 2 patients (0.68%) and 5 patients (1.7%), respectively. Alcohol consumption was reported in 97 patients (33.22%).
HBeAg was positive in 28 patients (9.6%) and 105 patients (35.96%) had a viral load greater than 2000IU/mL. Cytolysis concerning ALT was found in 18.83% of patients. On the FibroScan®, initial significant fibrosis was found in 56 out of 249 patients who performed the examination (22.49%).
In the untreated patient population, 76.24%, 23.76% and 0% were at low, intermediate and high risk of developing HCC (REACH-B), respectively. The incidence of cancer was almost the same as expected according to the REACH-B score at 3 and 5 years.
One hundred and eleven patients (n=111; 38%) were treated, of whom 56 patients (50.45%), 48 patients (43.24%) and 7 patients (6.31%) were at low, intermediate and high risk, respectively, of developing HCC according to the PAGE-B score at entry into the cohort.
During the study period, 11 patients (3.8%) developed HCC at 5 years, of which 10 (91%) came from treated patients. The incidence of HCC was increased in the group of patients treated, suggesting the existence of cofactors influencing the progression of the disease even under treatment.
In multivariate analysis; significant F≥2 fibrosis (p-value≤ 0.003, OR=12.3) and the presence of a family history of HCC (p-value≤ 0.008, OR=38) were associated with the risk of HCC occurrence.
Conclusion: The occurrence of HCC in follow-up cohorts of patients with chronic HBV is a major concern. Risk scores such as REACH-B and PAGE-B can be used in our context provided that they are adjusted to take into account certain cofactors such as aflatoxin and family history of HCC.

HCC, reach-B, Page -B, Ouagadougou