1. In this pilot program conducted in Ethiopia, researchers demonstrated the long-term benefits and feasibility of treatment for chronic hepatitis B (CHB) infections in an under-resourced setting.
Evidence rating level: 2 (Good)
It is estimated that 296 million people worldwide are living with chronic hepatitis B (CHB) infections. Complications from untreated CHB infections include liver cirrhosis, liver failure, and hepatocellular carcinoma (HCC). In sub-Saharan Africa, under 1% of people living with CHB receive treatment. Researchers aimed to determine the feasibility and efficacy of a large-scale CHB treatment program in Africa. This pilot treatment program took place in Addis Ababa, Ethiopia. Adults over age 18 with CHB infection, defined as being seropositive for hepatitis B surface antigen for > 6 months, were recruited for the study in 2015. Of the 1303 patients included in the study, 291 were started on antiviral therapy within the 5-year follow-up period. Treatment eligibility was based on the European Association for the Study of the Liver (EASL) Guidelines, including those with liver cirrhosis, significant liver fibrosis, ALT>80 IU/L with viral load >2000 IU/mL, or family history of HCC in first-degree relatives with viral load >2000 IU/mL. For those receiving treatment, the estimated 5-year HCC-free survival was 99.0% for patients without baseline cirrhosis, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p<0.001). Patients with decompensated cirrhosis at the start of the study had a higher risk of death during the follow-up period with an adjusted hazard ratio (AHR) of 44.6, 95% CI 6.1–328.1, as did those over age 40, AHR 3.7, 95% CI 1.6–8.5. Furthermore, treatment was associated with decreased liver stiffness, with a median change from baseline after 1, 3, and 5 years of treatment of −4.0 kPa,−5.2 kPa, and -5.6 kPa, respectively. This pilot program is evidence of treatment efficacy and feasibility of treating CHB infections in a resource-limited setting. Further work will hopefully include treatment programs for a greater number of people.
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