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.

Hematology and blood serum chemistry reference intervals for children in Iganga district of Uganda

In this study, normal ranges for hematology and serum biochemistry in children aged 1 to 5 years inUgandawere determined. By a cross-sectional study, 1168 children from Iganga, a prospective site for clinical trials in Uganda, were screened. From 1168 households, 460 children were selected for enrollment, while 600 (58%) were excluded because of either a history of fever in the previous 24 hours, presence of asexual malaria parasites in the peripheral blood or presence of fever. Accordingly, 460 children (39.4%) of median age = 3 years were enrolled in the baseline study. While the lower limits of hemoglobin, hematocrit levels, mean corpuscular volume and platelet counts for the Ugandan children were found to be less than conventional reference values of Caucasisan children, the white blood cell count reference values were higher than the international intervals. On the other hand, the upper limits of the reference intervals for serum transaminases, bilirubin, creatinine, urea, total protein and albumin in sera of the Ugandan children were higher than the corresponding values for a Caucasian pediatric population. This study showed that, if hematology test results of the Ugandan children were assessed against “imported” international reference values, up to 44.6% of the study participants would have been excluded from clinical trials or would have been reported as adverse events in such trials. The present study was not only the first report of serum biochemistry reference ranges for children aged one to five years in Uganda but also one of very few such studies in Africa.