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Five-year results of a treatment program for chronic hepatitis B in Ethiopia
BACKGROUND: In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543851/ https://www.ncbi.nlm.nih.gov/pubmed/37775742 http://dx.doi.org/10.1186/s12916-023-03082-4 |
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author | Desalegn, Hailemichael Orlien, Stian Magnus Staurung Aberra, Hanna Mamo, Eyerusalem Grude, Sine Hommersand, Kristina Berhe, Nega Gundersen, Svein Gunnar Johannessen, Asgeir |
author_facet | Desalegn, Hailemichael Orlien, Stian Magnus Staurung Aberra, Hanna Mamo, Eyerusalem Grude, Sine Hommersand, Kristina Berhe, Nega Gundersen, Svein Gunnar Johannessen, Asgeir |
author_sort | Desalegn, Hailemichael |
collection | PubMed |
description | BACKGROUND: In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-scale CHB treatment programs in sub-Saharan Africa. METHODS: Adults with CHB were enrolled in a pilot treatment program in Addis Ababa, Ethiopia, in 2015. Liver enzymes, viral markers, and transient elastography were assessed at baseline and thereafter at 6-month intervals. Tenofovir disoproxil fumarate was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. Survival analysis was performed using the Kaplan–Meier method. RESULTS: In total, 1303 patients were included in the program, of whom 291 (22.3%) started antiviral therapy within the initial 5 years of follow-up. Among patients on treatment, estimated 5-year hepatocellular carcinoma-free survival was 99.0% in patients without cirrhosis at baseline, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p < 0.001). The risk of death was significantly higher in patients with decompensated cirrhosis at baseline (adjusted hazard ratio 44.6, 95% confidence interval 6.1–328.1) and in patients older than 40 years (adjusted hazard ratio 3.7, 95% confidence interval 1.6–8.5). Liver stiffness declined significantly after treatment initiation; the median change from baseline after 1, 3, and 5 years of treatment was − 4.0 kPa, − 5.2 kPa, and − 5.6 kPa, respectively. CONCLUSIONS: This pilot program demonstrates the long-term benefits of CHB therapy in a resource-limited setting. The high mortality in patients with cirrhosis underscores the need for earlier detection of CHB and timely initiation of antiviral treatment in sub-Saharan Africa. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT02344498) on January 26, 2015. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-023-03082-4. |
format | Online Article Text |
id | pubmed-10543851 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-105438512023-10-03 Five-year results of a treatment program for chronic hepatitis B in Ethiopia Desalegn, Hailemichael Orlien, Stian Magnus Staurung Aberra, Hanna Mamo, Eyerusalem Grude, Sine Hommersand, Kristina Berhe, Nega Gundersen, Svein Gunnar Johannessen, Asgeir BMC Med Research Article BACKGROUND: In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-scale CHB treatment programs in sub-Saharan Africa. METHODS: Adults with CHB were enrolled in a pilot treatment program in Addis Ababa, Ethiopia, in 2015. Liver enzymes, viral markers, and transient elastography were assessed at baseline and thereafter at 6-month intervals. Tenofovir disoproxil fumarate was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. Survival analysis was performed using the Kaplan–Meier method. RESULTS: In total, 1303 patients were included in the program, of whom 291 (22.3%) started antiviral therapy within the initial 5 years of follow-up. Among patients on treatment, estimated 5-year hepatocellular carcinoma-free survival was 99.0% in patients without cirrhosis at baseline, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p < 0.001). The risk of death was significantly higher in patients with decompensated cirrhosis at baseline (adjusted hazard ratio 44.6, 95% confidence interval 6.1–328.1) and in patients older than 40 years (adjusted hazard ratio 3.7, 95% confidence interval 1.6–8.5). Liver stiffness declined significantly after treatment initiation; the median change from baseline after 1, 3, and 5 years of treatment was − 4.0 kPa, − 5.2 kPa, and − 5.6 kPa, respectively. CONCLUSIONS: This pilot program demonstrates the long-term benefits of CHB therapy in a resource-limited setting. The high mortality in patients with cirrhosis underscores the need for earlier detection of CHB and timely initiation of antiviral treatment in sub-Saharan Africa. TRIAL REGISTRATION: The study was registered at ClinicalTrials.gov (NCT02344498) on January 26, 2015. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-023-03082-4. BioMed Central 2023-09-29 /pmc/articles/PMC10543851/ /pubmed/37775742 http://dx.doi.org/10.1186/s12916-023-03082-4 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Desalegn, Hailemichael Orlien, Stian Magnus Staurung Aberra, Hanna Mamo, Eyerusalem Grude, Sine Hommersand, Kristina Berhe, Nega Gundersen, Svein Gunnar Johannessen, Asgeir Five-year results of a treatment program for chronic hepatitis B in Ethiopia |
title | Five-year results of a treatment program for chronic hepatitis B in Ethiopia |
title_full | Five-year results of a treatment program for chronic hepatitis B in Ethiopia |
title_fullStr | Five-year results of a treatment program for chronic hepatitis B in Ethiopia |
title_full_unstemmed | Five-year results of a treatment program for chronic hepatitis B in Ethiopia |
title_short | Five-year results of a treatment program for chronic hepatitis B in Ethiopia |
title_sort | five-year results of a treatment program for chronic hepatitis b in ethiopia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543851/ https://www.ncbi.nlm.nih.gov/pubmed/37775742 http://dx.doi.org/10.1186/s12916-023-03082-4 |
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