Autoimmune Liver Diseases in Native Black Africans: Extremely Rare or Inadequately Investigated Diseases?

Background: Autoimmune liver diseases (autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis) are conventionally considered to be very rare among native black Africans where chronic hepatitis B virus infection is the commonest cause of chronic liver disease. The question remains: “Are these diseases truly as rare as thought or are they under-investigated?”

Methods: The study was a non-systematic review. A comprehensive literature search, primarily in MEDLINE/PubMed, was conducted to identify articles in peer-reviewed journals in relation to the three traditional autoimmune liver diseases. The search was divided into three aspects: the global epidemiology of the diseases, the current status of the epidemiology of the diseases in sub-Saharan Africa, and the epidemiology of the diseases among African Americans for comparison because of shared genetic identity.

Results: The autoimmune livers diseases are relatively rare diseases that have not been well investigated globally. Majority of the epidemiological data concerning them are from the Western world with a handful from Asia. There are currently no population-based epidemiological surveys or well-structured prospective hospital-based studies that specifically investigated any of these diseases in the sub-Saharan African region, the home of the native black African population. More disturbing is the fact that there are very few case reports or case series of these diseases from the region.

Conclusion: Autoimmune liver diseases are grossly under-investigated and likely underreported among native black Africans and they may not be as rare as they are currently thought. Recent findings show that the prevalence rates of these diseases are increasing globally. It is, therefore, necessary to create more awareness of these diseases among physicians and the general public in the region.