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Chronic hepatitis B virus monoinfection at a university hospital in Zambia

World journal of Hepatology 2018年第9期10卷 622-628页

作者： 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 Tropical Gastroenterology and Nutrition Group School of MedicineUniversity of ZambiaLusaka 50110Zambia Centre for Infectious Disease Research in Zambia Lusaka 34681Zambia Department of Medicine University of Alabama at BirminghamBirminghamAL 35294United States Department of Infectious Diseases Bern University HospitalUniversity of BernBern 3012Switzerland Institute of Social and Preventive Medicine University of BernBern 3012Switzerland Zambia National Blood Transfusion Service Private Bag RW1X RidgewayLusaka 50110Zambia Zambian Ministry of Health Ndeke HouseLusaka 30205Zambia Department of Medicine University of California at Los AngelesLos AngelesCA 90035United States Blizard Institute Barts and The London School of MedicineQueen Mary University of LondonLondon E1 2ATUnited Kingdom Department of Medicine University of North Carolina at Chapel HillChapel HillNC 27514United States

AIM To characterize antiviral therapy eligibility among hepatitis B virus(HBV)-infected adults at a university hospital in *** Hepatitis B surface antigen-positive adults(n = 160) who were h IV-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-na?ve 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 treatmentexperienced individuals,we described medication side effects,adherence,and viral *** The median age was 33 years,71.9% were men,and 30.9% were diagnosed with HBV through a clinicallydriven test with the remainder identified via routine testing(at the blood bank,community events,etc.). Among 120 treatment-na?ve 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 treatmentexperienced 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/m L. CONCLUSION Approximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.

关键词： Hepatitis B virus Liver fibrosis Treatment Tenofovir Africa

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