Ndow Gibril, Gore Mindy L, Shimakawa Yusuke, Suso Penda, Jatta Abdoulie, Tamba Saydiba, Sow Amina, Touré-Kane Coumba, Sadiq Fouzia, Sabally Saihou, Njie Ramou, Thursz Mark R, Lemoine Maud
Division of Digestive Diseases, Department of Surgery & Cancer, St. Mary's Hospital Campus, Imperial College London, United Kingdom.
Hepatitis Unit, Disease Control & Elimination, MRC Unit The Gambia, Fajara, The Gambia.
PLoS One. 2017 Jun 14;12(6):e0179025. doi: 10.1371/journal.pone.0179025. eCollection 2017.
Compliance with WHO guidelines on HBV screening and treatment in HIV-coinfected patients is often challenging in resource limited countries and has been poorly assessed in sub-Saharan Africa.
Between 2015 and 2016, we assessed physician's compliance with WHO guidelines on HIV-HBV coinfection in the largest HIV clinic in The Gambia, and the hepatic outcomes in HIV-HBV coinfected patients as compared to randomly selected HIV-monoinfected controls.
870 HIV-infected patients regularly seen in this clinic agreed to participate in our study. Only 187 (21.5%, 95% CI 18.8-24.3) had previously been screened for HBsAg, 23 (12.3%, 95% CI 8.0-17.9) were positive of whom none had liver assessment and only 6 (26.1%) had received Tenofovir. Our HBV testing intervention was accepted by all participants and found 94/870 (10.8%, 95% CI 8.8-13.1) positive, 78 of whom underwent full liver assessment along with 40 HBsAg-negative controls. At the time of liver assessment, 61/78 (78.2%) HIV-HBV coinfected patients received ART with 7 (11.5%) on Tenofovir and 54 (88.5%) on Lamivudine alone. HIV-HBV coinfected patients had higher APRI score compared to controls (0.58 vs 0.42, p = 0.002). HBV DNA was detectable in 52/53 (98.1%) coinfected patients with 14/53 (26.4%) having HBV DNA >20,000 IU/L. 10/12 (83.3%) had at least one detectable 3TC-associated HBV resistance, which tended to be associated with increase in liver fibrosis after adjusting for age and sex (p = 0.05).
Compliance with HBV testing and treatment guidelines is poor in this Gambian HIV programme putting coinfected patients at risk of liver complications. However, the excellent uptake of HBV screening and linkage to care in our study suggests feasible improvements.
在资源有限的国家，遵守世界卫生组织关于艾滋病毒合并感染患者乙肝病毒筛查和治疗的指南往往具有挑战性，而在撒哈拉以南非洲地区，对此的评估一直很差。
在2015年至2016年期间，我们在冈比亚最大的艾滋病毒诊所评估了医生对艾滋病毒-乙肝病毒合并感染的世界卫生组织指南的遵守情况，并将艾滋病毒-乙肝病毒合并感染患者与随机选择的艾滋病毒单一感染对照患者的肝脏结局进行了比较。
该诊所870名经常就诊的艾滋病毒感染患者同意参与我们的研究。此前仅187名（21.5%，95%置信区间18.8 - 24.3）接受过乙肝表面抗原筛查，其中23名（12.3%，95%置信区间8.0 - 17.9）呈阳性，这些阳性患者均未进行肝脏评估，且仅6名（26.1%）接受过替诺福韦治疗。我们的乙肝病毒检测干预措施被所有参与者接受，结果发现94/870名（10.8%，95%置信区间8.8 - 13.1）呈阳性，其中78名接受了全面肝脏评估，同时还有40名乙肝表面抗原阴性对照患者。在进行肝脏评估时，61/78名（78.2%）艾滋病毒-乙肝病毒合并感染患者接受了抗逆转录病毒治疗，其中7名（11.5%）使用替诺福韦，54名（88.5%）仅使用拉米夫定。与对照患者相比，艾滋病毒-乙肝病毒合并感染患者的APRI评分更高（0.58对0.42，p = 0.002）。52/53名（98.1%）合并感染患者的乙肝病毒DNA可检测到，其中14/53名（26.4%）的乙肝病毒DNA>20,000 IU/L。10/12名（83.3%）至少有一种可检测到的与拉米夫定相关的乙肝病毒耐药性，在调整年龄和性别后，这往往与肝纤维化增加相关（p = 0.05）。
在这个冈比亚艾滋病毒项目中，对乙肝病毒检测和治疗指南的遵守情况很差，这使合并感染患者面临肝脏并发症的风险。然而，我们研究中对乙肝病毒筛查的良好接受度以及与治疗的衔接表明有可行的改进措施。
