#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia


Autoři: Michael J. Vinikoor aff001;  Edford Sinkala aff002;  Annie Kanunga aff002;  Mutinta Muchimba aff002;  Arianna Zanolini aff005;  Michael Saag aff001;  Jake Pry aff003;  Bright Nsokolo aff002;  Tina Chisenga aff007;  Paul Kelly aff002
Působiště autorů: Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, United States of America aff001;  Tropical Gastroenterology and Nutrition Group, University of Zambia School of Medicine, Lusaka, Zambia aff002;  Centre for Infectious Disease Research in Zambia, Lusaka, Zambia aff003;  Department of Medicine, University Teaching Hospital, Lusaka, Zambia aff004;  Department for International Development, Dar Es Salaam, Tanzania aff005;  University of California at Davis, Davis, California, United States of America aff006;  Zambian Ministry of Health, Lusaka, Zambia aff007;  Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom aff008
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0227041

Souhrn

Introduction

We evaluated antiviral therapy (AVT) eligibility in a population-based sample of adults with chronic hepatitis B virus (HBV) infection in Zambia.

Materials and methods

Using a household survey, adults (18+ years) were tested for hepatitis B surface antigen (HBsAg). Sociodemographic correlates of HBsAg-positivity were identified with multivariable regression. HBsAg-positive individuals were referred to a central hospital for physical examination, elastography, and phlebotomy for HBV DNA, hepatitis B e antigen, serum transaminases, platelet count, and HIV-1/2 antibody. We determined the proportion of HBV monoinfected adults eligible for antiviral therapy (AVT) based on European Association for the Study of the Liver (EASL) 2017 guidelines. We also evaluated the performance of two alternative criteria developed for use in sub-Saharan Africa, the World Health Organization (WHO) and Treat-B guidelines.

Results

Across 12 urban and 4 rural communities, 4,961 adults (62.9% female) were tested and 182 (3.7%) were HBsAg-positive, 80% of whom attended hospital follow-up. HBsAg-positivity was higher among men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 0.99–1.87) and with decreasing income (AOR, 0.89 per household asset; 95% CI, 0.81–0.98). Trends toward higher HBsAg-positivity were also seen at ages 30–39 years (AOR, 2.11; 95% CI, 0.96–4.63) and among pregnant women (AOR, 1.74; 95% CI, 0.93–3.25). Among HBV monoinfected individuals (i.e., HIV-negative) evaluated for AVT, median age was 31 years, 24.6% were HBeAg-positive, and 27.9% had HBV DNA >2,000 IU/ml. AVT-eligibility was 17.0% by EASL, 10.2% by WHO, and 31.1% by Treat-B. Men had increased odds of eligibility. WHO (area under the receiver operating curve [AUROC], 0.68) and Treat-B criteria (AUROC, 0.76) had modest accuracy. Fourteen percent of HBsAg-positive individuals were HIV coinfection, and most coinfected individuals were taking tenofovir-containing antiretroviral therapy (ART).

Conclusion

Approximately 1 in 6 HBV monoinfected adults in the general population in Zambia may be AVT-eligible. Men should be a major focus of hepatitis B diagnosis and treatment. Further development and evaluation of HBV treatment criteria for resource-limited settings is needed. In settings with overlapping HIV and HBV epidemics, scale-up of ART has contributed towards hepatitis B elimination.

Klíčová slova:

Antiviral therapy – Cirrhosis – Hepatitis B – Hepatitis B virus – HIV – Pregnancy – Treatment guidelines – Zambia


Zdroje

1. Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet. 2016.

2. World Health Organization. Global health sector strategy on viral hepatitis 2016–2021. Towards ending viral hepatitis. 2016.

3. Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. The Lancet. 2015;386(10003):1546–55.

4. World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. 2015.

5. World Health Organization. Guidelines on hepatitis B and C testing: policy brief. Geneva, Switzerland: 2016.

6. Lok AS, Zoulim F, Dusheiko G, Ghany MG. Hepatitis B cure: From discovery to regulatory approval. Journal of hepatology. 2017;67(4):847–61. doi: 10.1016/j.jhep.2017.05.008 28778687

7. Kiire C. The epidemiology and prophylaxis of hepatitis B in sub-Saharan Africa: a view from tropical and subtropical Africa. Gut. 1996;38(Suppl 2):S5–12.

8. Keane E, Funk A, Shimakawa Y. Systematic review with meta‐analysis: the risk of mother‐to‐child transmission of hepatitis B virus infection in sub‐Saharan Africa. Alimentary pharmacology & therapeutics. 2016;44(10):1005–17.

9. Kew MC, Kramvis A, Yu MC, Arakawa K, Hodkinson J. Increased hepatocarcinogenic potential of hepatitis B virus genotype A in Bantu‐speaking sub‐saharan Africans. Journal of medical virology. 2005;75(4):513–21. doi: 10.1002/jmv.20311 15714494

10. Kew MC, Geddes EW. Hepatocellular carcinoma in rural southern African blacks. Medicine. 1982;61(2):98–108. doi: 10.1097/00005792-198203000-00004 6174843

11. Lemoine M, Shimakawa Y, Njie R, Taal M, Ndow G, Chemin I, et al. Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study. The Lancet Global Health. 2016;4(8):e559–e67. doi: 10.1016/S2214-109X(16)30130-9 27443781

12. Aberra H, Desalegn H, Berhe N, Medhin G, Stene-Johansen K, Gundersen SG, et al. Early experiences from one of the first treatment programs for chronic hepatitis B in sub-Saharan Africa. BMC Infectious Diseases. 2017;17(1):438. doi: 10.1186/s12879-017-2549-8 28629395

13. Jaquet A, Nouaman M, Tine J, Tanon A, Anoma C, Inwoley A, et al. Hepatitis B treatment eligibility in West Africa: uncertainties and need for prospective cohort studies. Liver International. 2017.

14. Zambian Ministry of Health, Centers for Disease Control and Prevention, ICAP Columbia University, Central Statistics Office [Zambia]. Zambia Population-based HIV Impact Assessment (ZamPHIA): Final Report. Lusaka, Zambia: 2016.

15. Ministry of Health Community Development Gender Elderly and Children Tanzania, Ministry of Health Zanzibar, Centers for Disease Control and Prevention, ICAP Columbia University, National Bureau of Statistics [Tanzania], Office of Chief Government Statistician. Tanzania HIV Impact Survey (THIS). Dodoma, Tanzania: 2017.

16. Central Statistical Office (CSO) [Zambia] MoHMZ, and ICF International. Zambia Demographic and Health Survey 2013–14. Rockville, Maryland, USA: Central Statistical Office, Ministry of Health, and ICF International: 2014.

17. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT‐C as a Brief Screen for Alcohol Misuse in Primary Care. Alcoholism: Clinical and Experimental Research. 2007;31(7):1208–17.

18. Garson J, Grant P, Ayliffe U, Ferns R, Tedder R. Real-time PCR quantitation of hepatitis B virus DNA using automated sample preparation and murine cytomegalovirus internal control. Journal of virological methods. 2005;126(1):207–13.

19. Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(2):518–26. doi: 10.1053/jhep.2003.50346 12883497

20. Lemoine M, Shimakawa Y, Nayagam S, Khalil M, Suso P, Lloyd J, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut. 2016;65(8):1369–76. doi: 10.1136/gutjnl-2015-309260 26109530

21. European Association for the Study of the Liver. Clinical practice guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67:370–98. doi: 10.1016/j.jhep.2017.03.021 28427875

22. Shimakawa Y, Njie R, Ndow G, Vray M, Mbaye PS, Bonnard P, et al. Development of a simple score based on HBeAg and ALT for selecting patients for HBV treatment in Africa. Journal of hepatology. 2018;69(4):776–84. doi: 10.1016/j.jhep.2018.05.024 30104154

23. Vinikoor MJ, Sinkala E, Chilengi R, Mulenga LB, Chi BH, Zyambo Z, et al. Impact of antiretroviral therapy on liver fibrosis among human immunodeficiency virus-infected adults with and without HBV coinfection in Zambia. Clinical infectious diseases. 2017;64(10):1343–9. doi: 10.1093/cid/cix122 28158504

24. Nsokolo B, Kanunga A, Sinkala E, Zyambo K, Kumwenda D, Chama D, et al. Stage of disease in hepatitis B virus infection in Zambian adults is associated with large cell change but not well defined using classic biomarkers. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2017;111(9):425–32. doi: 10.1093/trstmh/trx077 29378031

25. Cooke GS, Andrieux-Meyer I, Applegate TL, Atun R, Burry JR, Cheinquer H, et al. Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission. The Lancet Gastroenterology & Hepatology. 2019;4(2):135–84.

26. Aberra H, Desalegn H, Berhe N, Mekasha B, Medhin G, Gundersen SG, et al. The WHO guidelines for chronic hepatitis B fail to detect half of the patients in need of treatment in Ethiopia. Journal of hepatology. 2019;70(6):1065–71. doi: 10.1016/j.jhep.2019.01.037 30929749

27. Johannessen A, Aberra H, Desalegn H, Gordien E, Berhe N. A novel score to select patients for treatment in chronic hepatitis B: Results from a large Ethiopian cohort. Journal of hepatology. 2019.

28. Hoffmann CJ, Thio CL. Clinical implications of HIV and hepatitis B co-infection in Asia and Africa. Lancet Infect Dis. 2007;7(6):402–9. doi: 10.1016/S1473-3099(07)70135-4 17521593

29. Feldacker C, Makunike-Chikwinya B, Holec M, Bochner AF, Stepaniak A, Nyanga R, et al. Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe. Global health action. 2018;11(1):1414997. doi: 10.1080/16549716.2017.1414997 29322867

30. Stabinski L, Reynolds SJ, Ocama P, Laeyendecker O, Serwadda D, Gray RH, et al. Hepatitis B virus and sexual behavior in Rakai, Uganda. Journal of medical virology. 2011;83(5):796–800. doi: 10.1002/jmv.22051 21412787

31. Seremba E, Ssempijja V, Kalibbala S, Gray RH, Wawer MJ, Nalugoda F, et al. Hepatitis B incidence and prevention with antiretroviral therapy among HIV-positive individuals in Uganda. AIDS. 2017;31(6):781–6. doi: 10.1097/QAD.0000000000001399 28099188

32. Wahome E, Ngetsa C, Mwambi J, Gelderblom HC, Manyonyi GO, Micheni M, et al., editors. Hepatitis B virus incidence and risk factors among human immunodeficiency virus-1 negative men who have sex with men in Kenya. Open forum infectious diseases; 2016: Oxford University Press US.

33. Zambian Ministry of Health. Implementation Framework and Clinical Guidance for Viral Hepatitis Prevention and Treatment. Lusaka, Zambia: 2019.

34. Raimondo G, Caccamo G, Filomia R, Pollicino T. Occult HBV infection. Semin Immunopathol. 2012;34(4).


Článek vyšel v časopise

PLOS One


2020 Číslo 1
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#