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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Chronic hepatitis B virus infection in Eastern Ethiopia: Clinical characteristics and determinants of cirrhosis
Nejib Y Ismael, Semir A Usmael, Nega B Belay, Hailemichael Desalegn Mekonen, Asgeir Johannessen, Stian MS Orlien
Nejib Y Ismael, Semir A Usmael, Department of Internal Medicine, Haramaya University, College of Health and Medical Sciences, Harar 252, Ethiopia
Nega B Belay, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa 1000, Ethiopia
Nega B Belay, Asgeir Johannessen, Stian MS Orlien, Regional Centre for Imported and Tropical Diseases, Oslo University Hospital, Oslo 0450, Ullevål, Norway
Hailemichael Desalegn Mekonen, Internal Medicine, Gastroenterology and Hepatology Unit, Saint Paul’s Hospital Millennium Medical College, Addis Ababa 1000, Ethiopia
Hailemichael Desalegn Mekonen, Asgeir Johannessen, Stian MS Orlien, Department of Infectious Disease, Vestfold Hospital Trust, Tønsberg 3103, Norway
Asgeir Johannessen, Institute of Clinical Medicine, Oslo University, Oslo 0318, Norway
Stian MS Orlien, Department of Pediatrics, Oslo University, Oslo 0450, Ullevål, Norway
Co-first authors: Nejib Y Ismael and Semir A Usmael.
Author contributions: Belay NB, Mekonen HD, Johannessen A, and Orlien SMS conceptualized and designed the research study; Ismael NY and Usmael SA participated in the data acquisition, analysis and interpretation of the data; Usmael SA drafted the initial manuscript; All of the authors revised the article critically for important intellectual content and gave approval for final version of the article. Ismael NY and Usmael SA efforts were equal in this work and as such merit co-first authorship.
Supported by the Norwegian Research Council, 220622/H10.
Institutional review board statement: The study was reviewed and approved by the National Research Ethics Review Committee (Ref. No. 3.10/829/07) in Ethiopia and by the Regional Committees for Medical and Health Research Ethics (Ref. No. 2014/1146) in Norway, as well as the pertinent institutional ethical review boards.
Informed consent statement: All study participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Semir A Usmael, MD, Assistant Professor, Department of Internal Medicine, Haramaya University, College of Health and Medical Sciences, Jinella Street, Harar 252, Ethiopia. semirabdi61@gmail.com
Received: February 23, 2024
Revised: June 14, 2024
Accepted: July 5, 2024
Published online: July 27, 2024
Processing time: 153 Days and 16 Hours
BACKGROUND
Chronic hepatitis B (CHB) virus infection is a major cause of liver-associated morbidity and mortality, particularly in low-income countries. A better understanding of the epidemiological, clinical, and virological characteristics of CHB will guide appropriate treatment strategies and improve the control and management of CHB in Ethiopia.
AIM
To investigate the characteristics of CHB in Eastern Ethiopia and assess the efficacy and safety of antiviral treatment.
METHODS
This cohort study included 193 adults who were human immunodeficiency virus-negative with CHB between June 2016 and December 2019. Baseline assessments included chemistry, serologic, and viral markers. χ2 tests, Mann-Whitney U tests, and logistic regression analyses were used to identify the determinants of cirrhosis. Tenofovir disoproxil fumarate (TDF) was initiated using treatment criteria from the Ethiopian CHB pilot program.
RESULTS
A total of 132 patients (68.4%) were men, with a median age of 30 years [interquartile range (IQR): 24-38]. At enrollment, 60 (31.1%) patients had cirrhosis, of whom 35 (58.3%) had decompensated cirrhosis. Khat use, hepatitis B envelope antigen positivity, and a high viral load were independently associated with cirrhosis. Additionally, 66 patients (33.4%) fulfilled the treatment criteria and 59 (30.6%) started TDF. Among 29 patients who completed 24 months of treatment, the median aspartate aminotransferase to platelet ratio index declined from 1.54 (IQR: 0.66-2.91) to 1.10 (IQR: 0.75-2.53) (P = 0.002), and viral suppression was achieved in 80.9% and 100% of patients after 12 months and 24 months of treatment, respectively. Among the treated patients, 12 (20.3%) died within the first 6 months of treatment, of whom 8 had decompensated cirrhosis.
CONCLUSION
This study highlights the high prevalence of cirrhosis, initial mortality, and the efficacy of TDF treatment. Scaling up measures to prevent and control CHB infections in Ethiopia is crucial.
Core Tip: In this study, we investigated the characteristics and efficacy of antiviral treatment in 193 patients who were human immunodeficiency virus-negative and participated in a pilot chronic hepatitis B treatment program in Eastern Ethiopia. Notably, one-third of the patients had cirrhosis at enrollment, reflecting poor access to hepatitis B virus services in the study area. Tenofovir disoproxil fumarate treatment was highly effective in achieving viral suppression and improving the levels of liver fibrosis markers. However, the initial mortality rate was high owing to the high proportion of patients with decompensated cirrhosis. This finding highlights the importance of scaling up national hepatitis B virus prevention and control programs.
