Five-year results of a treatment program for chronic hepatitis B in Ethiopia

Background In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-...

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Published in:BMC medicine 2023-09, Vol.21 (1), p.1-373, Article 373
Main Authors: Desalegn, Hailemichael, Orlien, Stian Magnus Staurung, Aberra, Hanna, Mamo, Eyerusalem, Grude, Sine, Hommersand, Kristina, Berhe, Nega, Gundersen, Svein Gunnar, Johannessen, Asgeir
Format: Article
Language:English
Subjects:
Alcohol
Antiretroviral drugs
Antiviral agents
Antiviral drugs
Antiviral treatment
Biochemistry
Care and treatment
Cirrhosis
Cohort analysis
Development and progression
Health hazards
Hematology
Hepatitis
Hepatitis B
Hepatitis B virus
Hepatitis C
Hepatitis delta virus
Hepatocellular carcinoma
HIV
Human immunodeficiency virus
Infections
Liver
Liver cancer
Liver cirrhosis
Longitudinal cohort study
Patient outcomes
Public health
Resource-limited settings
Survival
Survival analysis
Tenofovir
Therapy
Ultrasonic imaging
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Summary:Background In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-scale CHB treatment programs in sub-Saharan Africa. Methods Adults with CHB were enrolled in a pilot treatment program in Addis Ababa, Ethiopia, in 2015. Liver enzymes, viral markers, and transient elastography were assessed at baseline and thereafter at 6-month intervals. Tenofovir disoproxil fumarate was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. Survival analysis was performed using the Kaplan-Meier method. Results In total, 1303 patients were included in the program, of whom 291 (22.3%) started antiviral therapy within the initial 5 years of follow-up. Among patients on treatment, estimated 5-year hepatocellular carcinoma-free survival was 99.0% in patients without cirrhosis at baseline, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p < 0.001). The risk of death was significantly higher in patients with decompensated cirrhosis at baseline (adjusted hazard ratio 44.6, 95% confidence interval 6.1-328.1) and in patients older than 40 years (adjusted hazard ratio 3.7, 95% confidence interval 1.6-8.5). Liver stiffness declined significantly after treatment initiation; the median change from baseline after 1, 3, and 5 years of treatment was - 4.0 kPa, - 5.2 kPa, and - 5.6 kPa, respectively. Conclusions This pilot program demonstrates the long-term benefits of CHB therapy in a resource-limited setting. The high mortality in patients with cirrhosis underscores the need for earlier detection of CHB and timely initiation of antiviral treatment in sub-Saharan Africa. Trial registration The study was registered at ClinicalTrials.gov (NCT02344498) on January 26, 2015. Keywords: Hepatitis B virus, Antiviral treatment, Survival analysis, Resource-limited settings, Longitudinal cohort study
ISSN:1741-7015
1741-7015
DOI:10.1186/s12916-023-03082-4