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Evaluation of the Strategy and Efficacy of Treatment of Chronic Viral Hepatitis C with the Sofosbuvir/Daclatasvir Combination in a Resource-Limited Country

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Open Journal of Gastroenterology 2024年第7期14卷 233-240页

作者： mayanna habkreo Ali Mahamat Moussa Adama Ahmed Ngare Abdraman Kossou Tahir Mahamat Saleh Maire Dehainsala Mahamat Ali Hachim Mahamat Ali Bolti Oumaima Djarma Joseph Madtoingue Service de Gastroentrologie/Mdecine Interne du Centre Hospitalier Universitaire la Rfrence Nationale NDjamena Chad Service de Gastroentrologie du Centre Hospitalier Universitaire la Renaissance NDjamena Chad Service de Maladies Infectieuses du Centre Hospitalier Universitaire la Renaissance NDjamena Chad Service de Maladies Infectieuses du Centre Hospitalier Universitaire la Rfrence Nationale NDjamena Chad

Introduction: The treatment of viral hepatitis C (HCV), a major public health problem, has evolved considerably since the introduction of direct-acting anti-virals (DAAs). The aim of this study was to evaluate the strategy for initiating treatment with Sofosbuvir/Daclatasvir, and also to assess its efficacy. Patients and Methods: Included were patients aged at least 15 years, with detectable hepatitis C viremia and treated with a pan-genotypic Sofosbuvir/Daclatasvir regimen at the Centre “Hospitalier Universitaire la Référence Nationale de N’Djamena” between October 2019 and October 2023. The APRI score was used to assess fibrosis. Cure was defined by an undetectable viral load 12 weeks after the end of treatment. Results: A total of 835 patients were included (sex ratio 1.55, mean age 50.5 ± 13.73, extremes 20 and 84 years). The 60 - 69 age group was the most represented. The mean APRI score was 0.42 ± 0.29, with extremes of 0.019 and 1.84. The mean viral load was 2,316,193.086 IU/mL. All subjects had good renal function. Cytolysis was absent in 70% of cases. Without genotyping, a pan-genotypic regimen was used in all patients: Sofosbuvir (400 mg)/Daclatasvir (60 mg). The cure rate was 99.4%, with good tolerability. However, four cases of failure were recorded out of the 668 patients who underwent follow-up HCV-PCR testing after 12 weeks of treatment. Conclusion: The Sofosbuvir/Daclatasvir regimen is highly effective, with an excellent safety profile. However, the still high cost of these molecules limits their accessibility to a large proportion of patients.

关键词： Efficacy Tolerance Sofosbuvir/Daclatasvir HCV Chad

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Frequency of Viral Replication Markers in Chronic HBV Carriers in N’Djamena, Chad

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Open Journal of Gastroenterology 2022年第10期12卷 271-277页

作者： Ali Mahamat Moussa mayanna habkreo Adawaye Chatté Borde Emmanuel Adoum Abdelrazack Fouda Bessimbaye Nadlaou Service de Médecine Interne et Gastroentérologie CHU La Référence Nationale de N’Djamena N’Djamena Tchad Département des Sciences Biomédicales et Pharmaceutiques Faculté des Sciences de la Santé Humaine Université de N’Djamena N’Djamena Tchad Programme National de Lutte Contre le VIH/IST/Hépatite Ministère de la Santé Publique N’Djamena Tchad

Introduction: According to the WHO, Chad is located in an area of high endemicity for hepatitis B virus (HBV). The aim of this study was to analyze the virological profiles of chronic HBV carriers. Materials and Method: This was a retrospective and analytical study including outpatients with chronic HBV of any age received in Department of Internal Medicine and Gastroenterology of National General Reference Hospital of N’Djamena from 2013 to 2017. Results: During the study period, 401 chronic hepatitis B virus carriers (mean age was 35 years ± 11 years with sex ratio of 3.26) were seen in outpatient clinic with a frequency of 3.34% (401/11,988). HBeAg (+) patients were 12.8% and HBeAg negative 87.2%. HBeAg-negative patients were significantly older (p = 0.000) than those with HBeAg (+). The mean HBV-DNA level was higher in HBeAg (+) patients. The HBV-DNA level in HBeAg-positive patients was higher than in HBeAg-negative patients with a significant difference (p = 0.043). The mean ALT level was 45 IU/L in HBeAg (−) patients. It was 49 in HBeAg (+) patients. Conclusion: HBeAg (−) chronic hepatitis B is the most predominant form in our study. This observation is important because it can help to adapt the management strategies.

关键词： Chronic Hepatitis B Epidemiology HBeAg Viral Replication Ndjamena Chad

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Prevalence and Predictors of Viral Hepatitis D Co-Infection in Chronic HbsAg Carriers

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Open Journal of Gastroenterology 2022年第9期12卷 213-220页

作者： Ali Mahamat Moussa Tahir Mahamat Saleh mayanna habkreo Bessimbaye Nadlaou Adama Ahmed Ngare Doffou Adjeka Stanislas Assi Constant Service de Medecine Interne & Gastroentérologie CHU La Référence Nationale N’Djamena Tchad Service de Medecine Interne CHU La Renaissance N’Djamena Tchad Service de Laboratoire CHU La Référence Nationale N’Djamena Tchad

The characteristics of viral hepatitis B and D co-infection are poorly documented in Chad. The aim of our study was to determine the prevalence of HBV/HDV co-infection and the characteristics of this co-infection. Materials and Methods: This was a retrospective study including all patients with chronic HBsAg carriers referred in our department from January 2014 to December 2018. Non-inclusion criteria were: absence of anti-HDV testing, presence of anti-viral hepatitis C or Human Immunodeficiency Virus antibodies or excessive alcohol consumption. The variables studied were age, sex, blood transaminase level, HBV DNA level, HDV RNA level, and liver fibrosis and activity score (Actitest Fibrotest). The prevalence of HDV and the characteristics of HDV/HBV co-infection were determined. Results: During the study period, 403 patients were seen in these two hospitals for chronic HBsAg carriage. Of these, 378 (75%) had performed the anti HDV assay. Anti-HDV antibodies were positive in 53 patients (14%). In multivariate analysis, HBV/HDV co-infected patients were less frequently HBeAg positive (5.4% vs. 28.1%;p = 0.0001), older (35 years vs. 32 years;p = 0.001), and more frequently had significant necrotic-inflammatory activity (3.9% vs. 3.2%;p = 0.031) compared with mono infected patients. Neither gender (76.9% male vs. 77.4% male;p = ns), nor viral load (median 530 IU/ml vs. 195 IU/ml;p = ns), nor significant liver fibrosis (35.1% vs. 47.1%;p = ns), nor transaminases (median 26 vs. 32 IU/ml) were different with mono infected patients. Conclusion: VHD is common in Chad. It is associated with increased hepatic necrotic-inflammatory activity.

关键词： Viral Hepatitis D (Anti VHD Ac) Prevalence Favouring Factors Necrotic-Inflammatory Activity Chad

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Hepatocellular Carcinoma in Chad: A Retrospective Study of 219 Cases

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Open Journal of Gastroenterology 2023年第11期13卷 382-392页

作者： Ali Mahamat Moussa Pascal Pineau mayanna habkreo Gumbo Nedjim Tahir Mahamat Saleh Adoum Abderrazak Fouda Mahamat Ali Hachim Adawaye Chatté Bessimbaye Nadlaou Moussa Kalli Choua Ouchemi Service de Médecine Interne et Gastroentérologie Centre Hospitalier Universitaire La Référence Nationale N’Djamena Tchad Unité “Organisation Nucléaire et Oncogenèse” Institut National de la Santé et de la Recherche Médicale U993 Paris France Service de Médecine Interne Centre Hospitalier Universitaire La Renaissance N’Djamena Tchad Programme de Lutte contre le VIH et SIDA Hépatites et Infectins Sexuellement Transmissibles Ministère de la Santé Publique N’Djamena Tchad Service du Laboratoire Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad Service de Chirurgie Générale Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad

Background: Although hepatocellular carcinoma was historically considered an important scourge in Middle Africa, there is no publication describing this disease in Chad. Methods: We conducted a retrospective analysis of 219 patients with hepatocellular carcinoma (HCC) attending care at the University Reference Hospital of Ndjamena between 2007 and 2016. Results: This series of HCC was characterized by a male predominance (M:F = 2.4) with a mean tumor onset at the end of the fifth decade of life (49.9 ± 14.7 years). Tumors appear on a cirrhotic liver in 70% of cases and were already multifocal at diagnosis in two thirds of the patients. Alpha-fetoprotein was above the physiological threshold (10 ng/mL) in 73.4% of cases measured and above the so-called diagnostic level (400 ng/mL) in 53.4% of patients. The principal risk factor was chronic infection with hepatitis B virus, detected in 52.6% of cases. Patients seropositive for hepatitis C virus were infrequent (8.6%) and heavy alcohol intake was even less prevalent (5.9%). Remarkably, a very large subset of patients did not present any infectious or lifestyle risk factor (43.4%). Mean AFP values or fibrosis assessment scores are usually lower in these patients than in HBV-infected ones. Conclusions: The etiological spectrum of HCC is far from being fully established in Chad. Further epidemiological research is warranted to identify risk factors involved in a large proportion of cases. Exposure to aflatoxin B1 and dysmetabolic conditions affecting the liver have to be investigated as priority.

关键词： Chad Middle Africa Hepatocellular Carcinoma Hepatitis Viruses Alcohol Idiopathic

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Risk Factors of Liver Cirrhosis in Chad: Large Proportion of Cases without Clear Etiology

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Open Journal of Gastroenterology 2023年第11期13卷 339-350页

作者： Ali Mahamat Moussa Pascal Pineau mayanna habkreo Moussa Hassan Elefi Tahir Mahamat Saleh Maire Dehainsala Mahamat Ali Hachim Adama Ahmed N’Gare Adoum Abderrazak Fouda Bessimbaye Nadlaou Adawaye Chatté Service de Médecine Interne et Gastroentérologie Centre Hospitalier Universitaire La Référence Nationale Ndjamena Tchad Unité “Organisation Nucléaire et Oncogenèse” Institut National de la Santé et de la Recherche Médicale U993 Paris France Service de Medecine Interne Centre Hospitalier Universitaire La Renaissance N’Djamena Tchad Programme de Lutte contre le VIH et SIDA Hépatites et Infectins Sexuellement Transmissibles Ministère de la Santé Publique N’Djamena Tchad Service de Laboratoire Centre Hospitalier Universitaire La Reference Nationale N’Djamena Tchad

Background: In comparison to other forms of chronic liver diseases, cirrhosis is generally poorly studied in sub Saharan Africa. In Chad, more particularly, no data are available despite the burden of liver diseases considered as the first cause of hospitalizations in the country. Methods: We conducted a retrospective analysis of 268 patients with liver cirrhosis attending care at the University Reference Hospital between 2007 and 2016. Results: This series of liver cirrhoses was characterized by a weak mal predominance (M:F = 1.7). The age of onset occurs significantly earlier in women than in men (40.6 ± 12.0 vs. 44.4 ± 13.4, p = 0.0171). The principal risk factor was persistent infection with hepatitis B virus (49% of cases) followed distantly by infection with hepatitis C virus (13%) and excessive alcohol consumption (10%). Men were more frequently carrying HBV surface antigen than women (65.6% vs 35.9% p = 0.0019). HBV-associated liver cirrhosis was overall more severe than diseases from other causes. A large proportion of cirrhosis (30%), observed primarily in women (48.1% vs 24.1%, p = 0.0036), was considered are cryptogenic. Conclusions: The etiological spectrum of liver cirrhosis remains to be properly defined in Chad. This lack of knowledge prevents the implementation of an efficient policy of prevention. A significant effort should be secured to characterize hitherto neglected infectious, lifestyle or genetic risk factors responsible of this form of terminal disease and improve subsequently liver health of local populations.

关键词： Chad Liver Cirrhosis Hepatitis Viruses Alcohol Cryptogenic

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Frequency of Viral Replication Markers in Chronic HBV Carriers in N’Djamena, Chad

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Open Journal of Gastroenterology（肠胃病学期刊） 2022年第10期

作者： ali mahamat moussa mayanna habkreo adawaye chatté borde emmanuel adoum abdelrazack fouda bessimbaye nadlaou

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Prevalence and Predictors of Viral Hepatitis D Co-Infection in Chronic HbsAg Carriers

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Open Journal of Gastroenterology（肠胃病学期刊） 2022年第9期

作者： ali mahamat moussa tahir mahamat saleh mayanna habkreo bessimbaye nadlaou adama ahmed ngare doffou adjeka stanislas assi constant

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Hepatocellular Carcinoma in Chad: A Retrospective Study of 219 Cases

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Open Journal of Gastroenterology（肠胃病学期刊） 2023年第11期

作者： Ali Mahamat Moussa Pascal Pineau mayanna habkreo Gumbo Nedjim Tahir Mahamat Saleh Adoum Abderrazak Fouda Mahamat Ali Hachim Adawaye Chatté Bessimbaye Nadlaou Moussa Kalli Choua Ouchemi

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Risk Factors of Liver Cirrhosis in Chad: Large Proportion of Cases without Clear Etiology

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Open Journal of Gastroenterology（肠胃病学期刊） 2023年第11期

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