Hépatite B chronique: aspects épidémiologique, diagnostique, thérapeutique et évolutif au centre hospitalier universitaire Yalgado Ouédraogo de Ouagadougou

Abstract

The aim of this study was to describe epidemiological, diagnosis, therapeutic, and evolutionary aspects of chronic hepatitis B.Patients and methodsIt is a clinical practice study carried out from May 2005 to June 2009 in the Hepatogastroenterology Department of Yalgado-Ouédraogo Teaching Hospital in Ouagadougou. Patients with chronic hepatitis B have been followed regularly during this period. We included all patients aged over 15 with HbsAg-positive over 6 months.ResultsA total of 433 patients cohort were enrolled among 290men (66.9%). Themean age was 32 years. Circumstances of finding out chronic hepatitis B were: blood donation (53.6%), medical checkup (34.1%), asthenia, jaundice, and increased transaminases (12.5%). Duration of HBsAg carrier state varied from 1 to 23 years, with a mean age of 3.3 ± 3.6 years. In HBeAg2 384 patients (88.6%) were positive. Forty patients (23.2%) had an inactive HBsAg carrier status. In HBeAg-negative chronic hepatitis B, 70.3% of patients had persistent or intermittent elevation in transaminase levels. HBV-DNA was positive in 74.3% tested patients with a mean viral load of 1,300,646 UI/ml (6.1 log). In HBe-positive chronic hepatitis B, 71.4% of patients had persistent or intermittent elevation in transaminase levels. HBV-DNA was positive in 89.4% patients with a mean viral load of 15,000,000 UI/ml (7.1 log). We treated 62 patients: 77.7% HBeAg-negative. Sixty patients (96.7%) have been treated with lamivudine, one patient with adefovir, and another one with entecavir. In treated patients, 71.8% achieved normalization of transaminase levels. Virologic response was complete in 25 patients (40.3%) and partial in 32 patients (51.6%). In 4 of 60 lamivudine-treated patients, lamivudine resistance occurred in four cases (6.6%). A 34-year-old man presented a small hepatocellular carcinoma. Partial hepatectomy was performed. In treated patients, HBeAg loss occurred in 2 of 13 HBeAg positive patients (15.4%) and none in HBsAg. In nontreated patients, HBeAg loss occurred in 4 of 36 patients (11.1%). We observed HBsAg loss in 6 of 371 patients (1.6%) and the appearance of HBs antibody in four patients.