Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2018; 10(9): 622-628
Published online Sep 27, 2018. doi: 10.4254/wjh.v10.i9.622
Chronic hepatitis B virus monoinfection at a university hospital in Zambia
Michael J Vinikoor, Edford Sinkala, Annie Kanunga, Mutinta Muchimba, Bright Nsokolo, Roma Chilengi, Gilles Wandeler, Joseph Mulenga, Tina Chisenga, Debika Bhattacharya, Michael S Saag, Graham Foster, Michael W Fried, Paul Kelly
Michael J Vinikoor, Edford Sinkala, Annie Kanunga, Mutinta Muchimba, Bright Nsokolo, Paul Kelly, Tropical Gastroenterology and Nutrition Group, School of Medicine, University of Zambia, Lusaka 50110, Zambia
Michael J Vinikoor, Roma Chilengi, Centre for Infectious Disease Research in Zambia, Lusaka 34681, Zambia
Michael J Vinikoor, Michael S Saag, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Gilles Wandeler, Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern 3012, Switzerland
Gilles Wandeler, Institute of Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland
Joseph Mulenga, Zambia National Blood Transfusion Service, Private Bag RW1X Ridgeway, Lusaka 50110, Zambia
Tina Chisenga, Zambian Ministry of Health, Ndeke House, Lusaka 30205, Zambia
Debika Bhattacharya, Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90035, United States
Graham Foster, Paul Kelly, Blizard Institute, Barts and The London School of Medicine, Queen Mary University of London, London E1 2AT, United Kingdom
Michael W Fried, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, United States
Author contributions: Vinikoor MJ, Sinkala E and Kelly P conceived the study; Vinikoor MJ, Sinkala E, Kanunga A and Muchimba M managed study implementation; Vinikoor MJ wrote the first draft of the manuscript; all authors provided critical review of the analysis, read and approved the final manuscript.
Supported by School of Medicine at University of Alabama at Birmingham; Fogarty International Center, No. K01TW009998; National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, No. U01AI069924; and Swiss National Science Foundation (to Wandeler G), No. PZ0093_154730.
Institutional review board statement: The study was reviewed and approved by the Biomedical Research Ethics Committee at University of Zambia (Lusaka, Zambia) and the Institutional Review Board at University of Alabama at Birmingham (Birmingham, AL, United States).
Informed consent statement: All participants provided written informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The STROBE Statement has been adopted.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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 http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael J Vinikoor, MD, Assistant Professor, Department of Medicine, University of Alabama at Birmingham, BBRB 256, 845 19th Street South, Birmingham, AL 35294, United States. mjv3@uab.edu
Telephone: +1-260-972921285
Received: April 26, 2018
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

This is the first Southern African study to apply international HBV criteria.

Research perspectives

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.