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



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.


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).


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


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