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      Characterization and assessment of HBV chronically infected patients: Identification of those eligible for treatment in the South West region of Cameroon

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          Abstract

          Background

          The management of patients with chronic hepatitis B infection is quite complex because it requires an in-depth knowledge of the natural history of the disease. This study was aimed at characterizing HBV infected patients in order to determine the phase of the infection and identify the proportion eligible for treatment using 3 different guidelines.

          Methods

          HBV chronically infected patients (negative for HIV and HCV) were enrolled and the following tests were done for them: ALT, AST, HBV viral load, HBV serologic panel and Full blood count. APRI score was calculated for all patients. These patients were classified into immunotolerant, immune clearance, immune control and immune escape phases of the infection. The WHO and the 2018 AASLD criteria was also used to identify those who need treatment. Patients were clinically examined for signs and symptoms. Questionnaire was administered to all participants to ascertain their treatment status. Statistical analysis was done using SPSS version 21.

          Results

          A total of 283 participants (101 females and 182 males) with a mean age of 31.3±8.5 were enrolled. Fifty-two (18.4%) were eligible for treatment (Immune clearance and immune escape phases) and they recorded a significantly higher mean APRI score (0.71±0.51) as compared to those in the immune control and immune tolerant phase (0.43±0.20). Based on WHO and AASLD criteria, 12(4.2%) and 15 (5.3%) were eligible for treatment respectively and these were all subsets of the 52 cases mentioned above. Six (2.1%) and 29 (10.2%) of those identified under the immune control phase were on tenofovir and traditional medication respectively.

          Conclusion

          Considering treatment for patients in the immune clearance and immune escape phases of the infection can be a reliable strategy to implement in our setting as this may probably tie with considerations from other treatment guidelines. Fifty-two (18.4%) patients were eligible for treatment and none of them were among the 2.1% of patients put on Tenofovir based treatment. This calls for the need for more trained health experts to periodically assess patients, implement an adequate treatment guideline and place the right patients on treatment in Cameroon.

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          Most cited references24

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          Acceptability and feasibility of a screen-and-treat programme for hepatitis B virus infection in The Gambia: the Prevention of Liver Fibrosis and Cancer in Africa (PROLIFICA) study

          Despite the introduction of immunisation for hepatitis B virus (HBV) in the 1990s, HBV-related morbidity and mortality remain high in sub-Saharan Africa. Identification and treatment of asymptomatic people with chronic HBV infection should reduce the disease burden. We therefore assessed the feasibility of a screen-and-treat programme for HBV infection in The Gambia, west Africa, and estimated the proportion of HBV-infected people who had significant liver disease in need of treatment.
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            Clearance of hepatitis B e antigen in patients with chronic hepatitis B and genotypes A, B, C, D, and F.

            Persistence of hepatitis B e antigen (HBeAg) in chronic hepatitis B has been associated with increased risk for development of cirrhosis and hepatocellular carcinoma. Five hepatitis B virus genotypes were identified in Alaska Native persons; we analyzed clearance of HBeAg by age and genotype. In this prospective cohort study, 1158 Alaska Native persons throughout Alaska were tested serially for HBeAg for a median of 20.5 years and were genotyped. Initial and final HBeAg-positive specimens, time to clearance, age at clearance, and subsequent HBeAg results were analyzed for persons initially HBeAg-positive. Subsequent HBeAg results were analyzed for persons initially negative. Genotypes A, B, C, D, and F were identified. Genotype C persons initially HBeAg-positive were more likely than those with other genotypes to be positive on initial and final specimens (P < .001 for each) and time to HBeAg clearance was longer (P < .001). Age at which 50% of persons cleared HBeAg was <20 years for those infected with genotypes A, B, D, and F and 47.8 years in genotype C (P < .001). After losing HBeAg, those with genotypes C and F were more likely to revert to the HBeAg-positive state (P < .001). Genotype may have a strong effect on mode of transmission and outcome. Genotype C may have been responsible for most perinatal transmission, given that seroconversion from HBeAg occurs decades later than in other genotypes.
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              Natural history of chronic hepatitis B: phases in a complex relationship.

              Chronic hepatitis B (CHB) is a condition of global prevalence and its sequelae include cirrhosis and hepatocellular carcinoma. The natural history of CHB is a complex interplay of virological, environmental and host factors. The dynamic relationship between the virus and host evolves over the duration of the infection and different phases of the disease have been observed and described. These have been conceptualized in terms of the state of balance between the host immune system and the hepatitis B virus and have been given the labels immune tolerant, immune clearance, immune control and immune escape although other nomenclature is also used. Host factors, such as age at infection, determine progression to chronicity. Virological factors including hepatitis B viral load, mutations and genotype also have an impact on the adverse outcomes of the infection, as do hepatotoxic cofactors such as alcohol. Our understanding of the natural history of CHB has evolved significantly over the past few decades and characterizing the phase of disease of CHB remains an integral part of managing this virus in the clinic.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: Writing – original draftRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: MethodologyRole: ValidationRole: Writing – review & editing
                Role: MethodologyRole: ResourcesRole: ValidationRole: Visualization
                Role: InvestigationRole: MethodologyRole: Validation
                Role: MethodologyRole: ResourcesRole: VisualizationRole: Writing – review & editing
                Role: InvestigationRole: Methodology
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Visualization
                Role: InvestigationRole: Methodology
                Role: SupervisionRole: Visualization
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                5 September 2018
                2018
                : 13
                : 9
                : e0203312
                Affiliations
                [1 ] Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
                [2 ] Buea Regional Hospital, Buea, South West Region, Cameroon
                [3 ] Department of Biological science, Faculty of Science, University of Bamenda, Bamenda, North West Region, Cameroon
                [4 ] Department of Public health and Hygiene, Faculty of Health science, University of Buea, Buea, South West Region, Cameroon
                [5 ] BioCollections Worldwide Inc., Miami, FL, United States of America
                [6 ] Department of internal medicine, Faculty of Health science, University of Buea, Buea, South West Region, Cameroon
                [7 ] Department of Medical Laboratory Science, Faculty of Health science, University of Buea, Buea, South West Region, Cameroon
                [8 ] Department of Biochemistry and Molecular Biology, Faculty of Science, University of Buea, Buea, South West Region, Cameroon
                Centre de Recherche en Cancerologie de Lyon, FRANCE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-5643-0515
                http://orcid.org/0000-0001-5526-9179
                Article
                PONE-D-18-15901
                10.1371/journal.pone.0203312
                6124766
                30183765
                868d4a1d-650e-49c0-976d-74ea6c1e5652
                © 2018 Tufon et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 27 May 2018
                : 18 August 2018
                Page count
                Figures: 7, Tables: 5, Pages: 19
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Health Care
                Health Care Policy
                Treatment Guidelines
                Biology and Life Sciences
                Developmental Biology
                Fibrosis
                Biology and Life Sciences
                Microbiology
                Virology
                Viral Transmission and Infection
                Viral Load
                Medicine and health sciences
                Infectious diseases
                Viral diseases
                Hepatitis
                Hepatitis B
                Medicine and health sciences
                Gastroenterology and hepatology
                Liver diseases
                Infectious hepatitis
                Hepatitis B
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Liver Diseases
                Cirrhosis
                Biology and Life Sciences
                Biochemistry
                Enzymology
                Enzymes
                Transferases
                Aminotransferases
                Biology and Life Sciences
                Biochemistry
                Proteins
                Enzymes
                Transferases
                Aminotransferases
                People and Places
                Geographical Locations
                Africa
                Cameroon
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Flaviviruses
                Hepacivirus
                Hepatitis C virus
                Biology and life sciences
                Microbiology
                Medical microbiology
                Microbial pathogens
                Viral pathogens
                Flaviviruses
                Hepacivirus
                Hepatitis C virus
                Medicine and health sciences
                Pathology and laboratory medicine
                Pathogens
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                Viral pathogens
                Flaviviruses
                Hepacivirus
                Hepatitis C virus
                Biology and life sciences
                Organisms
                Viruses
                Viral pathogens
                Flaviviruses
                Hepacivirus
                Hepatitis C virus
                Biology and life sciences
                Microbiology
                Medical microbiology
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis C virus
                Medicine and health sciences
                Pathology and laboratory medicine
                Pathogens
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis C virus
                Biology and life sciences
                Organisms
                Viruses
                Viral pathogens
                Hepatitis viruses
                Hepatitis C virus
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