Antoine Jaquet1,2, Marcellin Nouaman3, Judicaël Tine4, Aristophane Tanon5, Camille Anoma6, André Inwoley7, Alain Attia8, Didier K Ekouevi1,2,3,9, Moussa Seydi4, François Dabis1,2, Gilles Wandeler4,10,11. 1. Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France. 2. Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France. 3. Programme PACCI, CHU de Treichville, Abidjan, Cote d'Ivoire. 4. Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Senegal. 5. Service de maladies infectieuses et tropicales, CHU de Treichville, Abidjan, Cote d'Ivoire. 6. ONG Clinique de Confiance d'Abidjan, Abidjan, Cote d'Ivoire. 7. CeDReS, CHU de Treichville, Abidjan, Cote d'Ivoire. 8. Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Cote d'Ivoire. 9. Département de Santé Publique, Faculté des Sciences de la santé, Université de Lome, Lome, Togo. 10. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. 11. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND & AIMS: While universal screening of hepatitis B virus (HBV) is recommended in high burden countries, little is known about the proportion of HBV-infected persons in need of antiviral therapy in these settings. METHODS: Prisoners in Senegal and Togo as well as female sex workers and men who have sex with men in Cote d'Ivoire were screened for HBV infection. All HBsAg-positive participants underwent transient elastography, alanine aminotransferase (ALT) and HBV viral load (VL) quantification. Individuals with cirrhosis or those aged >30 years with an HBV replication ≥20 000 IU/mL and elevated ALT were considered eligible for antiviral therapy. RESULTS: Of 1256 participants, 110 (8.8%) were HBsAg positive; their median age was 30 years [interquartile range: 25-33] and 96 (86.5%) were men. Three individuals (2.7%) had cirrhosis, while 28 (29.5%) of 94 participants with available measurements had an HBV VL ≥20 000 IU/mL. Overall, 11 (10.0%) subjects were considered eligible for immediate antiviral treatment (2.1% of participants in Dakar, 7.7% in Abidjan and 21.6% in Lome, P=.001) and 59 (53.4%) for close monitoring due to the presence of significant liver fibrosis, elevated ALT or significant HBV replication. CONCLUSIONS: Among vulnerable populations in West Africa, a minority of HBV-infected individuals were eligible for immediate antiviral therapy. Prospective cohort studies are necessary to evaluate anti-HBV treatment eligibility facing the significant proportion of individuals with active chronic HBV infection.
BACKGROUND & AIMS: While universal screening of hepatitis B virus (HBV) is recommended in high burden countries, little is known about the proportion of HBV-infectedpersons in need of antiviral therapy in these settings. METHODS: Prisoners in Senegal and Togo as well as female sex workers and men who have sex with men in Cote d'Ivoire were screened for HBV infection. All HBsAg-positive participants underwent transient elastography, alanine aminotransferase (ALT) and HBV viral load (VL) quantification. Individuals with cirrhosis or those aged >30 years with an HBV replication ≥20 000 IU/mL and elevated ALT were considered eligible for antiviral therapy. RESULTS: Of 1256 participants, 110 (8.8%) were HBsAg positive; their median age was 30 years [interquartile range: 25-33] and 96 (86.5%) were men. Three individuals (2.7%) had cirrhosis, while 28 (29.5%) of 94 participants with available measurements had an HBV VL ≥20 000 IU/mL. Overall, 11 (10.0%) subjects were considered eligible for immediate antiviral treatment (2.1% of participants in Dakar, 7.7% in Abidjan and 21.6% in Lome, P=.001) and 59 (53.4%) for close monitoring due to the presence of significant liver fibrosis, elevated ALT or significant HBV replication. CONCLUSIONS: Among vulnerable populations in West Africa, a minority of HBV-infected individuals were eligible for immediate antiviral therapy. Prospective cohort studies are necessary to evaluate anti-HBV treatment eligibility facing the significant proportion of individuals with active chronic HBV infection.
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