Ethiopian Chronic Hepatitis B Treatment Pilot Project

1. In this pilot project in Ethiopia, researchers demonstrate the long-term benefits and feasibility of treating chronic hepatitis B (CHB) infection in a resource-poor setting.

Evidence rating level: 2 (good)

An estimated 296 million people worldwide have chronic hepatitis B (CHB) infection. Complications caused by untreated CHB infection include cirrhosis, liver failure, and hepatocellular carcinoma (HCC). In sub-Saharan Africa, less than 1% of people with chronic hepatitis B receive treatment. Researchers aimed to determine the feasibility and effectiveness of large-scale chronic hepatitis B treatment programs in Africa. The pilot treatment program is taking place in Addis Ababa, Ethiopia. In 2015, the study enrolled adults aged 18 years and older with CHB infection (defined as hepatitis B surface antigen seropositivity for more than 6 months). Of the 1,303 patients included in the study, 291 began antiviral treatment follow-up within 5 years. Treatment eligibility is based on European Association for the Study of the Liver (EASL) guidelines and includes patients with cirrhosis, significant liver fibrosis, ALT >80 IU/L and viral load >2000 IU/mL or a family history of HCC with viral load >2000 First-degree relative IU/mL. For treated patients, the estimated 5-year HCC-free survival rate was 99.0% for patients without baseline cirrhosis, compared with 88.8% for patients with compensated cirrhosis and 54.2% for patients with decompensated cirrhosis (p<0.001). Patients with decompensated cirrhosis at study entry had a higher risk of death during follow-up, with an adjusted hazard ratio (AHR) of 44.6, 95% CI 6.1–328.1, as did patients older than 40 years, with an AHR of 3.7 , 95% CI 1.6–8.5. Additionally, treatment was associated with reduced liver stiffness, with median changes from baseline of -4.0 kPa, -5.2 kPa, and -5.6 kPa after 1, 3, and 5 years of treatment, respectively. This pilot program demonstrates efficacy and feasibility of treating chronic hepatitis B infection in a resource-limited setting. Further work is expected to include bringing treatment options to more people.

Click to read the BMC Medicine study

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