Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

• Published in: BMC infectious diseases 2017-06, Vol.17 (1), p.438-438, Article 438
• Main Authors: Aberra, Hanna, Desalegn, Hailemichael, Berhe, Nega, Medhin, Girmay, Stene-Johansen, Kathrine, Gundersen, Svein Gunnar, Johannessen, Asgeir
• Format: Article
• Language: English
• Subjects: Adult; Adults; Africa; AIDS-Related Opportunistic Infections - virology; Alanine; Alanine transaminase; Alanine Transaminase - blood; Alcohol; Antiviral Agents - therapeutic use; Antiviral therapy; Biomarkers; Blood & organ donations; Cirrhosis; Cohort Studies; Coinfection - drug therapy; Diagnosis; Disease prevention; Drug therapy; Epidemiology; Ethics; Ethiopia; Family medical history; Female; Fibrosis; Hepatitis; Hepatitis B; Hepatitis B e antigen; Hepatitis B e Antigens - blood; Hepatitis B virus; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - drug therapy; HIV; Hospitals; Human immunodeficiency virus; Humans; Infections; Interferon; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - drug therapy; Liver Cirrhosis - virology; Liver diseases; Male; Middle Aged; Patients; Pilot Projects; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Regression analysis; Resource-limited settings; Tenofovir; Tenofovir - therapeutic use; Viral Load; Viruses; Young Adult
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2549-8

Treatment for chronic hepatitis B (CHB) is virtually absent in sub-Saharan Africa. Here we present early experiences from a pilot program for treatment of CHB in Ethiopia. Adults (≥18 years) with CHB were included in a cohort study at St. Paul's Hospital Millennium Medical College, Addis Ababa, from February 2015. The baseline assessment included liver function tests, viral markers and transient elastography (Fibroscan 402, Echosense, France). Logistic regression models were used to identify predictors of fibrosis. Tenofovir disoproxil fumarate (TDF) was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. The initial 300 patients underwent a more comprehensive evaluation and are presented here. One-hundred-and-thirty-eight patients (46.0%) were women and median age was 30 years (interquartile range 26-40). Co-infections were rare: four patients (1.3%) were anti-HCV positive, 11 (3.7%) were anti-HDV positive, whereas 5 (1.7%) had HIV-infection. The majority were hepatitis B e-antigen (HBeAg) negative (n = 262; 90.7%) and had a normal (≤40 U/L) alanine aminotransferase (ALT) (n = 245; 83.1%). Of 268 patients with a valid Fibroscan result, 79 (29.5%) had significant fibrosis (>7.9 kPa). Independent predictors of fibrosis were male sex, age > 35 years and viral load >20,000 IU/ml. In total, 74 patients (24.7%) started TDF therapy, of whom 46 (62.2%) had cirrhosis. The majority were HBeAg negative and had normal ALT. However, one quarter of the patients were in need of antiviral treatment, underscoring the need to scale up CHB treatment on the African continent. NCT02344498 ( ClinicalTrials.gov identifier). Registered 16 January 2015.