Chronic hepatitis B virus infection in Eastern Ethiopia: Clinical characteristics and determinants of cirrhosis

Abstract

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. χ ² 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.

Keywords: Chronic hepatitis B; Cirrhosis; Cohort study; Resource-limited settings; Sub-Saharan Africa.

Figure 1

Profile of chronic hepatitis B cohort study, Harar, Eastern Ethiopia. CHB: Chronic hepatitis B.

Figure 2

Clinical phase of 132 chronic hepatitis B patients with full data available, Harar, Eastern Ethiopia. Individualized analysis of hepatitis B virus DNA, alanine aminotransferase, and hepatitis B envelope antigen (HBeAg) status allowed phase classification of chronic hepatitis in 132 (68.4%) patients: 76 (57.6%) presented with HBeAg-negative chronic infection (inactive carrier), 7 (5.3%) with HBeAg-positive chronic infection, 19 (14.4%) with HBeAg-positive chronic hepatitis, and 21 (15.9%) with HBeAg-negative chronic hepatitis. In 61 (31.6%) patients, phase classification was not possible because of missing HBeAg or viral load data. CHB: Chronic hepatitis B.