viernes, 28 de julio de 2017

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa | BMC Infectious Diseases | Full Text

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa | BMC Infectious Diseases | Full Text

Biomed Central



BMC Infectious Diseases

Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa

  • Hanna Aberra,
  • Hailemichael Desalegn,
  • Nega Berhe,
  • Girmay Medhin,
  • Kathrine Stene-Johansen,
  • Svein Gunnar Gundersen and
  • Asgeir JohannessenEmail authorView ORCID ID profile
BMC Infectious DiseasesBMC series – open, inclusive and trusted201717:438
Received: 17 April 2017
Accepted: 14 June 2017
Published: 19 June 2017

Abstract

Background

Treatment 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.

Methods

Adults (≥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.

Results

One-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.

Conclusions

The 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 registration

NCT02344498 (ClinicalTrials.gov identifier). Registered 16 January 2015.

Keywords

Hepatitis B virus Antiviral therapy Resource-limited settings Africa

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