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World J Hepatol. 2018 Sep 27;10(9):622-628. doi: 10.4254/wjh.v10.i9.622.

Chronic hepatitis B virus monoinfection at a university hospital in Zambia.

Author information

1
Tropical Gastroenterology and Nutrition Group, School of Medicine, University of Zambia, Lusaka 50110, Zambia.
2
Centre for Infectious Disease Research in Zambia, Lusaka 34681, Zambia.
3
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern 3012, Switzerland.
4
Zambia National Blood Transfusion Service, Private Bag RW1X Ridgeway, Lusaka 50110, Zambia.
5
Zambian Ministry of Health, Ndeke House, Lusaka 30205, Zambia.
6
Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90035, United States.
7
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States.
8
Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London E1 2AT, United Kingdom.
9
Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, United States.

Abstract

AIM:

To characterize antiviral therapy eligibility among hepatitis B virus (HBV)-infected adults at a university hospital in Zambia.

METHODS:

Hepatitis B surface antigen-positive adults (n = 160) who were HIV-negative and referred to the hospital after a routine or clinically-driven HBV test were enrolled. Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), platelet count, hepatitis B e-antigen, and HBV DNA were measured. Liver fibrosis/cirrhosis was assessed by physical examination, AST-to-platelet ratio index, and transient elastography. In antiviral therapy-naïve individuals, we described HBV stages and antiviral therapy eligibility per World Health Organization (WHO) and by HBV test (routine vs clinical). Elevated ALT was > 19 in women and > 30 U/L in men. Among treatment-experienced individuals, we described medication side effects, adherence, and viral suppression.

RESULTS:

The median age was 33 years, 71.9% were men, and 30.9% were diagnosed with HBV through a clinically-driven test with the remainder identified via routine testing (at the blood bank, community events, etc.). Among 120 treatment-naïve individuals, 2.5% were categorized as immune tolerant, 11.7% were immune active, 35.6% were inactive carriers, and 46.7% had an indeterminate phenotype. Per WHO guidelines, 13 (10.8%) were eligible for immediate antiviral therapy. The odds of eligibility were eight times higher for those diagnosed at clinical vs routine settings (adjusted odds ratio, 8.33; 95%CI: 2.26-29.41). Among 40 treatment-experienced HBV patients, virtually all took tenofovir, and a history of mild side effects was reported in 20%. Though reported adherence was good, 12 of 29 (41.4%) had HBV DNA > 20 IU/mL.

CONCLUSION:

Approximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.

KEYWORDS:

Africa; Hepatitis B virus; Liver fibrosis; Tenofovir; Treatment

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