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
Africa has 60 million individuals living with chronic hepatitis B virus (HBV) infection yet limited data to inform how to identify, link to care, and treat them to reduce the burden of cirrhosis and liver cancer.
Not all HBV patients need antivirals. Estimates on how many do will guide policy implementation. Also, few data are available on patient adherence, retention, and viral suppression with current antiviral drugs.
Our objective was to perform a comprehensive clinical assessment on chronic HBV-infected adults in Zambia and apply international criteria to learn what percentage may need antiviral drugs. In those already on antivirals, we measured the viral control.
At a university hospital in Zambia, a cross-sectional assessment of adults (18+ years old) who were hepatitis B surface antigen positive and HIV negative was undertaken during 2016-2017. We used tests available in upper-income settings such as HBV DNA testing and transient elastography to assess HBV in these patients.
One hundred and sixty enrolled in the study, including 120 who were recently diagnosed with HBV and 40 already on antiviral drugs. The average age was 33, and 72% were men. We found that 1 in 10 met the World Health Organization guidelines to start antivirals; however, nearly 1 in 2 had at least one finding that would need clinical follow-up. Patients diagnosed because of signs or symptoms of HBV were slightly more likely to need antivirals compared to those diagnosed via routine testing (such as at the blood bank). Among those already on the antivirals, few had side effects; however, 41% did not completely control their viral load.
This is the first Southern African study to apply international HBV criteria.
Additional data are needed on whether those with high ALT or viral loads at baseline will later need antivirals. HBV testing that focuses on symptomatic individuals could be more efficient (than routine testing for all) to find those needing treatment but more information is needed.