Early Experiences from One of the First Treatment Programs for Chronic Hepatitis B in Sub-Saharan Africa

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.

Antiviral use among hepatitis B infected patients in a low resource setting in Africa: a case study of West Nile, Uganda

“…It highlights a need for further studies to refine the APRI score criterion and to identify other additional or stand-alone less-costly approaches to detecting liver fibrosis in low resource settings of SSA at an early stage. Investing in liver elastography that could facilitate use of the rather more accurate modified Western criteria 21 - 23 could also be a worthwhile option in countries like Uganda where government offers free HBV load testing to patients with chronic disease. In the meantime, training more health care providers and decentralizing disease management to lower health facilities would relieve the huge work load on the existing low staffing levels.…”

Hepatitis delta virus infection in a large cohort of chronic hepatitis B patients in Ethiopia

“…Tenofovir disoproxil fumarate (TDF) was provided free of charge to patients in the programme. The treatment eligibility criteria used in this programme have been described previously …”

“…In February 2015, a treatment programme for CHB was established at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Among the initial 300 patients, we recently reported a low HDV antibody seroprevalence of 3.7% . In this study, conducted on this same cohort comprising now 1267 patients, we aimed to (i) determine the prevalence of chronic HDV infection using state‐of‐the‐art diagnostic assays; (ii) describe the main epidemiological, clinical, biological and virological features of HDV‐infected patients; and (iii) characterize HDV genotypes present in Ethiopia.…”