Published online Sep 27, 2018. doi: 10.4254/wjh.v10.i9.622
Peer-review started: April 26, 2018
First decision: May 9, 2018
Revised: May 23, 2018
Accepted: July 9, 2018
Article in press: July 10, 2018
Published online: September 27, 2018
To characterize antiviral therapy eligibility among hepatitis B virus (HBV)-infected adults at a university hospital in Zambia.
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.
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.
Approximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.
Core tip: Data to inform the scale-up of hepatitis B testing and treatment in Africa are badly lacking. Among 120 recently diagnosed hepatitis B surface antigen-positive and HIV negative adults in Zambia, Southern Africa, 10% met the WHO’s criteria for immediate antiviral therapy and an additional 40% had an “indeterminate” hepatitis B virus (HBV) phenotype with either elevated alanine aminotransferase or HBV DNA > 2000 IU/mL. Among 40 additional patients who were antiviral therapy-experienced (primarily with tenofovir), tolerability and adherence were good; however, nearly half had incomplete HBV DNA suppression. Effective approaches to retain antiviral-ineligible HBV patients in care will be important in Zambia.