Characteristics and antiviral treatment eligibility of newly diagnosed hepatitis B patients at a teaching hospital in Ghana: Implications for prevention and management

Abstract

AbstractHepatitis B virus (HBV) infection poses a considerable public health challenge in limited-resource settings especially in the sub-Saharan African region. Even though HBV infection is incurable, timely treatment is effective in preventing disease progression to liver cirrhosis or hepatocellular carcinoma. However, not all infected patients require treatment. The aim of this study was to determine the clinical, immunological, and virological profiles of newly diagnosed adult HBV patients at a tertiary healthcare center in Ghana and to determine the antiviral treatment eligibility rate based on current guidelines of the World Health Organization (WHO). A hospital-based cross-sectional study involving total sampling of 220 treatment naïve HBV surface antigen positive clients was carried out. A structured questionnaire was used to collect data and detailed clinical and laboratory assessment (serological, biochemical and virological) was carried out. Data were entered and analyzed with STATA version 16. The median age at diagnosis was 34 years (IQR 26.0 – 41.5) with a male to female ratio of 1:1.5. A total of 138 participants (62.7%) were diagnosed with HBV infection following voluntary testing. There was a median delay of 8.5 months (IQR 3.0 – 22.5) between initial diagnosis and patients’ presentation for medical care. In all, 24 patients (10.9%) had abnormal clinical examination findings, 172 patients (78.2%) had HBV DNA levels ≤ 2000 IU/ml while 8 (3.6%) were seropositive for HBeAg. A small proportion of patients had concomitant human immunodeficiency virus (2.7%) and hepatitis C virus (1.4%) infections. Treatment eligibility rate was very low among newly diagnosed HBV infected patients seeking medical care (n=14, 6.4%) following the WHO guidelines for treatment eligibility. Thus, increasing screening rate among the general population, early linkage to clinical care of screen positives and vaccination of screen negatives will help reduce HBV related clinical conditions in resource limited countries.