TITLE:
Treatment of HBeAg-Negative Chronic Hepatitis B Patients with Nucleos(t)ide Analogues in Burkina Faso
AUTHORS:
Kounpiélimé Sosthène Somda, Abdel Karim Sermé, Aboubacar Coulibaly, Steve Léonce Zoungrana, Inès Compaoré, Serges Kouamou, Damien Ouattara, Roger Sombié, Alain Bougouma
KEYWORDS:
Chronic Hepatitis B, HBeAg-Negative, Nucleos(t)ide Analogues, Tenofovir, Lamivudine, Burkina Faso
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.6 No.12,
December
12,
2016
ABSTRACT: The treatment of chronic
hepatitis B (CHB) has increased significantly in recent years. In patients
affected by HBeAg-negative CHB, it is necessary to distinguish the inactive
carriers (low viral DNA 2000
IU/mL, normal ALT, histological lesions absent or minimal) who does not need
treatment, and patients suffering from active CHB (DNA > 2000 IU/ml, high transaminases or fluctuating,
significant fibrosis and/or necro-inflammatory activity > 1) who must be treated. The main purpose of
treatment is to obtain a long-lasting viral suppression to improve the
histological lesions and reduce the risk of evolution towards cirrhosis, liver
failure and hepatocellular carcinoma (HCC). It about an indefinite treatment
(unless HBsAg seroclearance) expensive and often inaccessible for the majority
of our patients. Our study aimed to report the results of four years follow-up
of HBeAg-negative patients treated by Nucleos(t)ide analogues (NAs) in
Ouagadougou (Burkina Faso). It was a clinical observational study with 133
patients including 95 men; the average age was 41.2 years, completing the
criteria of treatment. One hundred and twelve patients were treated by
tenofovir (TDF), fourteen by lamivudine and seven co-infected HIV/HBV patients
by Atripla® (combination TDF, Emtricitabine and Efavirenz). Virological and
biochemical responses were respectively 100% and 94% after 4 years. The rate of
HBsAg seroclearance was 1.5%. Twelve of fourteen patients (85.7%) had
lamivudine resistance and no cases of resistance in the TDF and Atripla® groups. One co-infected patient developed HCC during treatment. Among patients
treated by TDF, two
cases of hypophosphatemia were noticed and no case of kidney failure. The
treatment of CHB is certainly progressing; updated guidelines (EASL, AASLD)
exist but should be adapted to the African context.