Chronic hepatitis B virus monoinfection at a university hospital in Zambia

AIM To characterize antiviral therapy eligibility among hepatitis B virus(HBV)-infected adults at a university hospital in Zambia.METHODS Hepatitis B surface antigen-positive adults(n = 160) who were h IV-negative and referred to the hospital after a routine or clinically-driven HBV test were enrolled. Alanine Aminotransferase(ALT),Aspartate Aminotransferase(AST),platelet count,hepatitis B e-antigen,and HBV DNA were measured. Liver fibrosis/cirrhosis was assessed by physical examination,AST-to-platelet ratio index,and transient elastography. In antiviral therapy-na?ve individuals,we described hBV stages and antiviral therapy eligibility per World health Organization(WhO) and by hBV test(routine vs clinical). Elevated ALT was > 19 in women and > 30 U/L in men. Among treatmentexperienced individuals,we described medication side effects,adherence,and viral suppression.RESULTS The median age was 33 years,71.9% were men,and 30.9% were diagnosed with HBV through a clinicallydriven test with the remainder identified via routine testing(at the blood bank,community events,etc.). Among 120 treatment-na?ve individuals,2.5% were categorized as immune tolerant,11.7% were immune active,35.6% were inactive carriers,and 46.7% had an indeterminate phenotype. Per WhO guidelines,13(10.8%) were eligible for immediate antiviral therapy. The odds of eligibility were eight times higher for those diagnosed at clinical vs routine settings(adjusted odds ratio,8.33; 95%CI: 2.26-29.41). Among 40 treatmentexperienced hBV patients,virtually all took tenofovir,and a history of mild side effects was reported in 20%. Though reported adherence was good,12 of 29(41.4%) had HBV DNA > 20 IU/m L. CONCLUSION Approximately one in ten HBV-monoinfected Zambians were eligible for antivirals. Many had indeterminate phenotype and needed clinical follow-up.