Abstract
BackgroundTreatment 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.MethodsAdults (≥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.ResultsOne-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.ConclusionsThe 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.Trial registrationNCT02344498 (ClinicalTrials.gov identifier). Registered 16 January 2015.
Highlights
Treatment for chronic hepatitis B (CHB) is virtually absent in sub-Saharan Africa
In 2015, the World Health Organization (WHO) issued guidelines for the prevention, care and treatment for persons with CHB, with an emphasis on resource-limited settings [1], but still little is known about treatment indications and outcomes in sub-Saharan Africa
The antiviral regimens reported by these patients were: tenofovir disoproxil fumarate (TDF) (n = 15), TDF/lamivudine fixed-dose combination (n = 7), lamivudine (n = 3), and pegylated interferon (n = 4)
Summary
Treatment for chronic hepatitis B (CHB) is virtually absent in sub-Saharan Africa. Aberra et al BMC Infectious Diseases (2017) 17:438 of studies have demonstrated the safety and efficacy of antiviral treatment of HBV in high-income countries [4, 5, 8, 9]. These experiences, are not necessarily translatable to an African setting, where epidemiological, environmental and socioeconomic factors are different, which in turn might impact the natural history, disease progression and risk of cirrhosis and HCC [10]. It is imperative to improve access to hepatitis B treatment in Africa, and real-life experiences from African treatment cohorts are urgently needed to direct implementation, policy change and local treatment guidelines
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