Predictors of mortality in patients under treatment for chronic hepatitis B in Ethiopia: a prospective cohort study

Abstract

Background Antiviral treatment for chronic hepatitis B (CHB) is largely unavailable in sub-Saharan Africa; hence, little is known about the prognosis after initiating treatment in African CHB patients. In this study we aimed to assess predictors of mortality in one of the largest CHB cohorts in sub-Saharan Africa. Methods Two-hundred-and-seventy-six CHB patients who started treatment with tenofovir disoproxil fumarate at a public hospital in Ethiopia between March 18, 2015, and August 1, 2017, were included in this analysis. Patients were followed up until October 1, 2017, and deaths were ascertained through hospital records and telephone interview with relatives. Decompensated cirrhosis was defined as current or past evidence of ascites, either by clinical examination or by ultrasonography. Cox proportional hazard models were used to identify independent predictors of mortality. Results Thirty-five patients (12.7%) died during follow-up, 33 of whom had decompensated cirrhosis at recruitment. The median duration from start of treatment to death was 110 days (interquartile range 26–276). The estimated survival was 90.3, 88.2 and 86.3% at 6, 12 and 24 months of follow-up, respectively. Independent predictors of mortality were decompensated cirrhosis (adjusted hazard ratio [AHR] 23.68; 95% CI 3.23–173.48; p = 0.002), body mass index < 18.5 kg/m2 (AHR 3.65; 95% CI 1.73–7.72; p = 0.001) and older age (per 1-year increment; AHR 1.06; 95% CI 1.02–1.10; p = 0.007). Conclusions Decompensated cirrhosis, low body mass index and older age were independent predictors of mortality. Improved access to antiviral treatment and earlier initiation of therapy could improve the survival of African CHB patients. Trial registration NCT02344498 ( ClinicalTrials.gov identifier). Registered 16 January 2015.

Trends in the disease burden of HBV and HCV infection in China from 1990-2019

“…Since HBV-and HCV-associated deaths are mainly due to chronic liver diseases, such as cirrhosis and liver cancer, we analyzed the mortality-associated risk factors in patients with chronic hepatitis infections. It is known that many risk factors are asso- ciated with chronic HBV, including male sex ( Si et al, 2019 ), advanced age, low BMI ( Desalegn et al, 2019 ), alcohol use, high alanine aminotransferase ( Zhou et al, 2020a ), and decompensated cirrhosis ( Desalegn et al, 2019 ). HCV-associated factors include male sex, advanced age, and lifestyle, such as smoking and drinking ( Nguyen et al, 2009 ).…”

Diagnostic performance of non-invasive fibrosis markers for chronic hepatitis B in sub-Saharan Africa: a Bayesian individual patient data meta-analysis

“…Cohorts represented by HEPSANET group members were described in 21 articles. 11,13,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] We contacted corresponding authors from the remaining 3 articles, [43][44][45] and all authors agreed to contribute individual patient data. We additionally included unpublished data from three sites (Cape Town, South Africa; Thiès, Senegal; and Dakar, Senegal) and data from one additional study published since the search was conducted from Malawi.…”

Comprehensive investigating of mismatch repair genes (MMR) polymorphisms in participants with chronic hepatitis B virus infection

“…The gene-gene multiplicative interaction was evaluated by Logistic Regression model. The additive interaction analysis was carried out jointly by SPSS21.0 and Excel (2019). Firstly, calculate B, P, OR (95%CI) and covariance matrix with SPSS21.0.…”

“…This result was consistent with the results of other research teams. Studies have shown that HBV susceptibility factors include gender (male) ( Si et al, 2019 ) and advanced age ( Desalegn et al, 2019 ). In addition, smoking may increase susceptibility to HBV-HCC by affecting viral load ( Wang et al, 2019 ).…”