Abstract
BackgroundUnderstanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. The aim of this study was to determine the prevalence of different phases of CHB infection among Eritrean patients and to identify the proportion of patients who are eligible for treatment according to the latest American Association for the Study of Liver Diseases (AASLD) guidelines.MethodsThis cross-sectional study enrolled 293 CHB patients (213 males and 80 females) between Jan 2017 and Feb 2019. The patients were classified into immune-tolerant, immune-active, and inactive CHB phases of the infection, which is based on the results of Hepatitis B virus (HBV) serological panel (HBsAg, anti-HBc total, HBeAg, and anti-HBe), ALT levels, and HBV DNA viral load. The 2018 AASLD guidelines were also used to identify patients who needed treatment.ResultsThe mean age of the patients was 41.66 ± 13.84 years. Of these, 3 (1.0%) were at the immune tolerant phase, 58 (19.8%) at the immune-active CHB phase, and 232 (79.2%) at the inactive CHB phase. As most subjects (93%) were HBeAg-negative, based on AASLD guidelines, only 5 (1.7%) were currently eligible for treatment.ConclusionsOur data show that CHB patients in Eritrea were predominantly in the inactive CHB phase. Although initiating antiviral therapy is not recommended in these patients, periodic assessment of liver function and disease severity should be considered in patients older than 40 years. The immune-tolerant phase had the fewest patients, most of whom were aged above 20 years, attesting to the success of incorporating HBV vaccine in the national childhood immunization program since 2002. Our study shows that adopting AASLD treatment guidelines with adjustments to suit the local setting is a suitable option in the management of Eritrean CHB patients.
Highlights
Understanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients
Some patients enter the immune escape phase or the hepatitis B e antigen (HBeAg)-negative chronic hepatitis phase, which is characterized by a negative HBeAg test and reactivation of virus replication, leading to higher Hepatitis B virus (HBV) Deoxyribonucleic acid (DNA) levels compared with that observed in the low replicative phase
HBV viral load < 2000 IU/ ml was recorded in 226 patients, 40 patients had HBV viral load between 2000 and 20,000 IU/ml, while 27 patients had values > 20,000 IU/ml
Summary
Understanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. After decades (10–40 years) of CHB infection, many patients progress to the second phase, namely the immune clearance phase or the immune active HBeAgpositive phase This stage is categorized by observable immune-mediated liver damage, elevated ALT levels, detectable HBeAg, and lower HBV DNA (viral load) compared to the immune tolerant phase. Some patients enter the immune escape phase or the HBeAg-negative chronic hepatitis phase, which is characterized by a negative HBeAg test and reactivation of virus replication, leading to higher HBV DNA levels compared with that observed in the low replicative phase (inactive HBV carrier phase) This phase is associated with more severe and active liver damage and elevated ALT levels [4,5,6]
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