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

Vinikoor, Michael J; Sinkala, Edford; Kanunga, Annie; Muchimba, Mutinta; Nsokolo, Bright; Chilengi, Roma; Wandeler, Gilles; Mulenga, Joseph; Chisenga, Tina; Bhattacharya, Debika; Saag, Michael S; Foster, Graham; Fried, Michael W; Kelly, Paul (2018). Chronic hepatitis B virus monoinfection at a university hospital in Zambia. World journal of hepatology, 10(9), pp. 622-628. Baishideng Publishing Group Inc 10.4254/wjh.v10.i9.622

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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 ( = 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 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 routine testing (at the blood bank, community events, .). 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 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.

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