National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana.
Department of Microbiology and Immunology, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana.
PLoS One. 2024 Aug 22;19(8):e0302086. doi: 10.1371/journal.pone.0302086. eCollection 2024.
Hepatitis B virus (HBV) infection poses a considerable public health challenge in limited-resource settings especially in the sub-Saharan African region. Even though HBV infection is incurable, timely treatment is effective in preventing disease progression to liver cirrhosis or hepatocellular carcinoma. However, not all infected patients require treatment. The aim of the study was to determine the clinical, immunological, and virological profiles of treatment naïve patients with HBV infection, seen at the outpatient clinic of the Cape Coast Teaching Hospital. Additionally, the study sought to determine the antiviral treatment eligibility rate based on the 2015 guidelines of the World Health Organization (WHO) compared with the new 2024 guidelines. A hospital-based cross-sectional study involving total sampling of 220 treatment naïve HBV surface antigen positive clients was carried out. A structured questionnaire was used to collect data that were analyzed with STATA version 16. The median age at diagnosis was 34 years (IQR 26.0-41.5) with a male to female ratio of 1:1.5. A total of 138 participants (62.7%) were diagnosed with HBV infection following voluntary testing. There was a median delay of 8.5 months (IQR 3.0-22.5) between initial diagnosis and patients' presentation for medical care. In all, 24 patients (10.9%) had abnormal clinical examination findings, 172 patients (78.2%) had HBV DNA levels ≤ 2000 IU/ml whereas 8 (3.6%) were seropositive for the HBV envelope antigen. A few patients had concomitant human immunodeficiency virus (2.7%) and hepatitis C virus (1.4%) infections. Treatment eligibility rate based on the WHO 2015 guidelines was 6.4% (n = 14), however, with the updated 2024 guidelines, treatment eligibility was 42.3% (n = 93). Increasing the screening rate among the general population, early linkage to clinical care of screen positives and vaccination of screen negatives will help reduce HBV-related clinical conditions in resource-limited settings.
乙型肝炎病毒 (HBV) 感染在资源有限的环境中，特别是在撒哈拉以南非洲地区，构成了相当大的公共卫生挑战。尽管 HBV 感染无法治愈，但及时治疗可有效防止疾病进展为肝硬化或肝细胞癌。然而，并非所有感染患者都需要治疗。本研究旨在确定在开普敦教学医院门诊就诊的未经治疗的 HBV 感染患者的临床、免疫和病毒学特征。此外，该研究还旨在根据 2015 年世界卫生组织 (WHO) 指南和新的 2024 年指南确定抗病毒治疗的资格率。一项基于医院的横断面研究，对 220 名未经治疗的 HBV 表面抗原阳性患者进行了总抽样。使用结构化问卷收集数据，并使用 STATA 版本 16 进行分析。诊断时的中位年龄为 34 岁（IQR 26.0-41.5），男女比例为 1:1.5。共有 138 名参与者（62.7%）通过自愿检测被诊断为 HBV 感染。从初次诊断到患者就诊接受医疗护理的中位时间延迟为 8.5 个月（IQR 3.0-22.5）。共有 24 名患者（10.9%）出现异常临床检查结果，172 名患者（78.2%）HBV DNA 水平≤2000 IU/ml，而 8 名患者（3.6%）HBV 包膜抗原呈阳性。少数患者同时感染人类免疫缺陷病毒（2.7%）和丙型肝炎病毒（1.4%）。根据 WHO 2015 年指南，治疗资格率为 6.4%（n=14），然而，根据更新的 2024 年指南，治疗资格率为 42.3%（n=93）。在普通人群中增加筛查率、早期将筛查阳性者与临床护理联系起来以及对筛查阴性者进行疫苗接种，将有助于减少资源有限环境中的 HBV 相关临床疾病。
