Hepatitis B infection has become a public health issue in recent years. Approximately 350 million of the world’s population are chronically infected reaching endemic proportions in West Africa. Guidelines for treatment are continuously improving but are becoming more complex.
Aim
To determine the challenges hepatologists experience in the management of patients with chronic hepatitis B.
Methods
This was a cross-sectional descriptive study conducted among hepatologists in West Africa during a regional hepatitis conference in 2013.
Results
Forty-six hepatologists completed the questionnaire. When evaluating a patient for chronic hepatitis B, the preferred investigations were: LFT (100%); abdominal ultrasound (93.5%); HBeAg (93.5%); HBV DNA (78%); HBsAg measure (22%); HBV genotype (15.2%); and liver biopsy (34.8%). Most had their patients on nucleoside/nucleotide analogue but follow-up visits after 1 year were problematic.
Conclusion
The majority of hepatologists had good intentions regarding the evaluation of their patients, but only a small percentage of patients are properly investigated.
LavanchyD. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat2004; 11: 97–107.
2.
McQuillanGMColemanPJKruszon-MoranDMoyerLALambertSBMargolisHS. Prevalence of hepatitis B virus infection in the United States: the National Health and Nutrition Examination Surveys, 1976 through 1994. Am J Pub Health1999; 89: 14–18.
3.
McMahonBJ. The natural history of chronic hepatitis B virus infection. Semin Liver Dis2004; 24: 17–21.
4.
MericanIGuanRAmarapukaDAlexanderMJChutaputtiAChienRN. Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol2000; 15: 1356–1361.
5.
KramvisAKewMC. Epidemiology of hepatitis B virus in Africa, its genotypes and clinical associations of genotypes. Hepatol Res2007; 37: S9–S19.
6.
MastEEMargolisHSFioreAEBrinkEWGoldsteinSTWangSA. A comprehensive immunization strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children, and adolescents. MMWR Recomm Rep2005; 54: 1–31.
7.
BeasleyRPTrepoCStevensCESzmunessW. The e antigen and vertical transmission of hepatitis B surface antigen. Am J Epidemiol1977; 105: 94–98.
8.
RoingeardPDioufASankaleJLBoyeCMboupSDiadhiouF. Perinatal transmission of hepatitis B virus in Senegal, west Africa. Viral Immunol1993; 6: 65–73.
9.
HoofnagleJHDooELiangTJFleischerRLokAS. Management of hepatitis B: summary of a clinical research workshop. Hepatology2007; 45: 1056–1075.
10.
LokASLaiCL. A longitudinal follow-up of asymptomatic hepatitis B surface antigen-positive Chinese children. Hepatology1988; 8: 1130–1133.
11.
LeePIChangMHLeeCYHsuHYChenJSChenPJ. Changes of serum hepatitis B virus DNAand aminotransferase levels during the course of chronic hepatitis B virus infection in children. Hepatology1990; 12: 657–660.
12.
HsuYSChienRNYehCTSheenISChiouHYChuCM. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology2002; 35: 1522–1527.
13.
HadziyannisSJVassilopoulosD. Hepatitis B e antigen-negative chronic hepatitis B. Hepatology2001; 34: 617–624.
14.
European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol2009; 50: 227–242.
15.
PerrilloRPSchiffERDavisGLBodenheimerHCJrLindsayKPayneJ. A randomized, controlled trial of interferon alfa-2b alone and after prednisone withdrawal for the treatment of chronic hepatitis B. The Hepatitis Interventional Therapy Group. New Engl J Med1990; 323: 295–301.
16.
WongDKCheungAMO’RourkeKNaylorCDDetskyASHeathcoteJ. Effect of alpha-interferon treatment in patients with hepatitis B e antigen-positive chronic hepatitis B. A meta-analysis. Ann Intern Med1993; 119: 312–323.
17.
TassopoulosNCVolpesRPastoreGHeathcoteJButiMGoldinRD. Efficacy of lamivudine in patients with hepatitis B e antigen-negative/hepatitis B virus DNA-positive (precore mutant) chronic hepatitis B. Hepatology1999; 29: 889–896.
18.
LaiCLShouvalDLokASChangTTCheinquerHGoodmanZ. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. N Engl J Med2006; 354: 1011–1020.
19.
TanJDegertekinBWongSNHusainMOberhelmanKLokAS. Tenofovir monotherapy is effective in hepatitis B patients with antiviral treatment failure to adefovir in the absence of adefovir-resistant mutations. J Hepatol2008; 48: 391–398.
20.
MostertMCRichardusJHde ManRA. Referral of chronic hepatitis B patients from primary to specialist care: making a simple guideline work. J Hepatol2004; 41: 1026–1030.
Lesi AO. Management of chronic hepatitis B. Challenges of wholesale application of international guidelines. Paper presented at the Roche regional hepatitis conference in Accra, Ghana. 2013.
FungJLaiCLSetoWKYuenMF. The use of transient elastography in the management of chronic hepatitis B. Hepatol Int2011; 5: 868–875.
25.
TsengTCLiuCJSuTHWangCCChenCLChenPJ. Serum hepatitis B surface antigen levels predict surface antigen loss in hepatitis B e antigen seroconverters. Gastroenterology2011; 141: 517–525.
26.
ChenYCJengWJChuCMLiawYF. Decreasing levels of HBsAg predict HBsAg seroclearance in patients with inactive chronic hepatitis B virus infection. Clin Gastroenterol Hepatol2012; 10: 297–302.
27.
YangHIYehSHChenPJIloejeUHJenCLSuJ. Associations between hepatitis B virus genotype and mutants and the risk of Hepatocellular carcinoma. J Natl Cancer Inst2008; 100: 1134–1143.
28.
BusterEHFlinkHJCakalogluYSimonKTrojanJTabakF. Sustained HBeAg and HBsAg loss after long-term follow-up of HBeAg-positive patients treated with peginterferon alpha-2b. Gastroenterology2008; 135: 459–467.
29.
LiuFWangLLiXYLiuYDWangJBZhangZH. Poor durability of lamivudine effectiveness despite stringent cessation criteria: a prospective clinical study in hepatitis B e antigen-negative chronic hepatitis B patients. J Gastroenterol Hepatol2011; 26: 456–460.
30.
MarcellinPBoninoFLauGKFarciPYurdaydinCPiratvisuthT. Sustained response of hepatitis B e antigen-negative patients 3 years after treatment with peginterferon alpha-2a. Gastroenterology2009; 136: 2169–2179.
