Abstract
The treatment of chronic hepatitis B (CHB) has increased significantly in recent years. In patients affected by HBeAg-negative CHB, it is necessary to distinguish the inactive carriers (low viral DNA 2000 IU/mL, normal ALT, histological lesions absent or minimal) who does not need treatment, and patients suffering from active CHB (DNA > 2000 IU/ml, high transaminases or fluctuating, significant fibrosis and/or necro-inflammatory activity > 1) who must be treated. The main purpose of treatment is to obtain a long-lasting viral suppression to improve the histological lesions and reduce the risk of evolution towards cirrhosis, liver failure and hepatocellular carcinoma (HCC). It about an indefinite treatment (unless HBsAg seroclearance) expensive and often inaccessible for the majority of our patients. Our study aimed to report the results of four years follow-up of HBeAg-negative patients treated by Nucleos(t)ide analogues (NAs) in Ouagadougou (Burkina Faso). It was a clinical observational study with 133 patients including 95 men; the average age was 41.2 years, completing the criteria of treatment. One hundred and twelve patients were treated by tenofovir (TDF), fourteen by lamivudine and seven co-infected HIV/HBV patients by Atripla® (combination TDF, Emtricitabine and Efavirenz). Virological and biochemical responses were respectively 100% and 94% after 4 years. The rate of HBsAg seroclearance was 1.5%. Twelve of fourteen patients (85.7%) had lamivudine resistance and no cases of resistance in the TDF and Atripla® groups. One co-infected patient developed HCC during treatment. Among patients treated by TDF, two cases of hypophosphatemia were noticed and no case of kidney failure. The treatment of CHB is certainly progressing; updated guidelines (EASL, AASLD) exist but should be adapted to the African context.
Highlights
With more than 350 million chronic carriers worldwide, about 5% of the world population, the hepatitis B virus (HBV) infection is a major problem of public health [1] [2] [3]
In patients affected by HBeAg-negative chronic hepatitis B (CHB), it is necessary to distinguish the inactive carriers who does not need treatment, and patients suffering from active CHB (DNA > 2000 IU/ml, high transaminases or fluctuating, significant fibrosis and/or necro-inflammatory activity > 1) who must be treated
Our study aimed to report the results of four years follow-up of HBeAg-negative patients treated by Nucleos(t)ide analogues (NAs) in Ouagadougou (Burkina Faso)
Summary
With more than 350 million chronic carriers worldwide, about 5% of the world population, the hepatitis B virus (HBV) infection is a major problem of public health [1] [2] [3]. Among these chronic carriers the morbidity and the mortality will be bound in 20% to 25% of the cases in a hepatic complication mainly the cirrhosis with the risk of fatal complications such as hepatic failure or hepatocellular carcinoma (HCC). The main goal of treatment is to get a dural viral suppression to improve the histological lesions and reduce the risk of progression to cirrhosis, liver failure and HCC
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