Rachel Musomba, Barbara Castelnuovo, Murphy Claire, Komujuni Charlene, Nyakato Patience, Ocama Ponsiano, Lamorde Mohammed, Easterbrook Philippa, Ratanshi Rosalind Parkes
Infectious Diseases Institute, Makerere University, Mulago Hospital, P.O. Box 22418, Kampala, Uganda.
Centre for Communicable Diseases, Queen Elizabeth University Hospital, Glasgow, Scotland.
Hepatol Med Policy. 2018 Jan 6;3:3. doi: 10.1186/s41124-017-0030-3. eCollection 2018.
WHO hepatitis B guidelines recommend testing all new HIV patients, treating them accordingly or providing immunization. At the Infectious Diseases Institute (IDI) following an audit done in 2012, only 46% patients had been screened for hepatitis B with variable management plans therefore new internal guidelines were implemented. This study describes the uptake of hepatitis B screening and management of patients with hepatitis B and HIV con-infection after the implementation.
Data included for all HIV positive patients in care at IDI by October 2015. Data are expressed as median with interquartile range (IQR) and percentages were compared using the chi square test. Statistical analysis was performed using STATA version 13. The IDI laboratory upper limit of normal for alanine aminotransferase (ALT) and aspartate aminotransferase (ASTs) was 40 IU/ml.
Number of hepatitis B screening tests increased from 800 by 2012 to 1400 in 2015. By 2015 8042/8604(93.5%) patients had been screened for hepatitis B. Overall hepatitis B positive were 359 (4.6%). 166 (81.4%) hepatitis B positives were switched to a tenofovir (TDF) containing regimen.
Our study confirms the importance of screening for hepatitis B and of using ART regimens containing tenofovir in hepatitis B co-infected patients. Whilst our program has made improvements in care still 18.6% of patients with hepatitis B were not on tenofovir regimens, 98.1% had no hepatitis B viral loads done. Clinicians should recognize the potential for hepatitis B in HIV positive patients and the importance of early diagnosis and treatment to ensure optimal management of cases and follow up.
世界卫生组织乙肝指南建议对所有新的HIV患者进行检测，根据检测结果进行相应治疗或提供免疫接种。2012年在传染病研究所（IDI）进行的一次审计显示，只有46%的患者接受了乙肝筛查，且管理方案各不相同，因此实施了新的内部指南。本研究描述了实施新指南后乙肝筛查的接受情况以及乙肝和HIV合并感染患者的管理情况。
纳入2015年10月前在IDI接受治疗的所有HIV阳性患者的数据。数据以中位数和四分位间距（IQR）表示，百分比采用卡方检验进行比较。使用STATA 13版进行统计分析。IDI实验室丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（ASTs）的正常上限为40 IU/ml。
乙肝筛查检测次数从2012年的800次增加到2015年的1400次。到2015年，8042/8604（93.5%）的患者接受了乙肝筛查。总体乙肝阳性患者为359例（4.6%）。166例（81.4%）乙肝阳性患者改用了含替诺福韦（TDF）的治疗方案。
我们的研究证实了对乙肝进行筛查以及在乙肝合并感染患者中使用含替诺福韦的抗逆转录病毒治疗方案的重要性。虽然我们的项目在治疗方面有所改进，但仍有18.6%的乙肝患者未采用替诺福韦治疗方案，98.1%的患者未检测乙肝病毒载量。临床医生应认识到HIV阳性患者感染乙肝的可能性，以及早期诊断和治疗对于确保病例的最佳管理和随访的重要性。
