Hepatitis B is one of the most prevalent human viral infections in the world, alongside HIV, Tuberculosis and Malaria [1] . It shares the same routes of transmission as HCV and HIV, and exposes populations to risks of co-infection with HBV/HIV, HBV/HCV, HCV/HIV [2] [3] . Hepatitis B affects the liver and its chronicity can induce liver fibrosis that can progress to cirrhosis and then Hepatocellular Carcinoma (HCC) which represents the fourth most common cancer in the world and the third causing the greatest number of deaths [4] . The prevalence of this infection is higher in West Africa and is 8% [1] . In Burkina Faso, 1.9 million people live with HBV [5] with an estimated prevalence between 12% - 14.5% [1] . The high cost of antivirals, but also the attachment to some ancestral practices of the populations lead them to resort to traditional medicine to satisfy their health need, although this disease is treated by modern medicine [6] . WHO estimates that 80% of the world’s population uses traditional medicine for their health needs. However, since 1994, Burkina Faso has integrated traditional pharmacopoeia into its health system, and scientific research on medicinal plants is encouraged [7] . It is, therefore, necessary to establish scientific bases of plants known to be active against HBV in order to validate their use for an effective and accessible control in the promotion of traditional medicine. We have undertaken the present, to carry out an observational study on patients of a traditional health practitioner treated by a recipe of plants Hepatib tiben made with Phyllantus amarus, Cassia nigricans and Balanites aegyptiae to evaluate its effectiveness against HBV.

The purpose of this study was to assess the effect of the Hepatib tiben recipe, made from whole plants of Phyllantus amarus and Cassia nigricans, Balanites aegyptiaca leaves and ingredients on some biological markers for monitoring patients with chronic HBV.

The sample of our study is characterized by a female predominance. Indeed, previous studies have shown that women are predominant in Burkina Faso and represent 51.7% of the population [10] . Yet according to the WHO, the transition to chronic hepatitis B is more common in men who are more exposed to complications such as cirrhosis [5] . These results could be explained by the fact that women are more receptive to sensitization and have more access to health centers in the case of prenatal assessments or follow-up of their children for example.

Most of our patients have an age between 20 and 40 years with the average age of 36.45 years (10.45). We see that young people are the most affected by hepatitis. This is not surprising since sexual activity is one of the main routes of transmission of viral hepatitis B, and this age corresponds to the most intense and sometimes uncontrollable period of sexual activity.

Biologically, there was a considerable decrease in viral load, 61.36% of cases and the disappearance of HBsAg was observed in 4.54% of cases or 02 patients. These results are close to those obtained by [11] where the disappearance of HBsAg was observed in 4.17% of cases. A study by Xia et al., found no difference between patients treated with Phyllanthus amarus and others with antiretrovirals that aim to decrease viral load [12] . This considerable decrease in viral load and the disappearance of HBsAg in our case could indeed be justified by the fact that the association of Cassia nigricans and leaves of Balanites aegyptiaca with Phyllantus amarus have greater properties pharmacotherapeutic than Phyllantus amarus alone, or that patients strictly followed the traditional health practitioner’s instructions during treatment that were to avoid alcohol and fatty foods, or spontaneous healing of patients. It should also be noted that some had already used other traditional or modern treatments before the start of this study. Indeed, the literature indicates a possibility of seroconversion of HBsAg, after a delay of several months to several years, when HBV DNA is detectable in blood and in the absence of HBsAg. This is called occult hepatitis B [13] . The incidence rate is 2% per year [14] . Randomized trials are recommended on a larger number of patients, including a control group treated with modern drugs (Tenofovir, Entecavir...) and over a long period, to better assess the impact of the Hépatib tiben recipe on the disappearance of HBsAg. In addition, a decrease in transaminases in 14 patients or 15.9% for ASAT and ALAT, which had values above the norm was observed after three months of treatment. Transaminases were evaluated at 9.09% for ASAT and ALAT respectively. It is slightly appreciable when we analyze the results of Djiguiba et al., in 2005 [15] , which after three months of treatment did not observe any significant change. This modification could be associated with a possible antiviral property since the recipe composed of Phyllantus amarus, Cassia nigricans and Balanites aegyptiaca is a cocktail of tannins that are known for their antiviral properties [16] [17] Cell lysis being at the origin of the increase of transaminases, one could also consider this decrease as being the consequence of an anti-inflammatory property all the more as constituents such as flavonoids, steroids endowed with anti-inflammatory properties are present in the studied plants [18] [19] . The difference between our results and those of others may be explained by a number of variables including extrinsic factors (method of preparation, storage conditions, dosage, dosage form, extraction solvent and dosage) and intrinsic (age, period of harvest of plants and nature of drug). In this study, Hepatitis tiben was administered at a dosage of 2 g/day or two capsules of 1g each. In previous studies, a dosage of 10 g/0.5 L water twice daily was adopted [14] and 5 g of leaves/ 1L water/day [11] . In addition, creatinine was assayed in all patients before and after treatment to assess the toxicity of the recipe on renal activity. In our study the biochemical parameter creatinine was unfavorable in only 01 patient probably due to non-compliance with the instructions or the association of Hepatitis tiben with other drugs. This proves that the recipe Hepatitis tiben does not greatly affect the kidneys.

It appears from our study that Hepatitis tiben which is a recipe made from Phyllantus amarus, Cassia nigricans, Balanitès aegyptiae and ingredients improves the health of patients with chronic HBV by causing a decrease in viral load and also normalization of transaminase activity after 90 days of treatment. It should also be noted that ingestion of this drug does not affect kidney activity. These results shed new light on the pharmacological potential of many traditional medicine and pharmacopoeia plants in Burkina Faso. In view of its effects, this drug can be an alternative to the treatment of chronic hepatitis B in developing countries such as Burkina Faso with a rich and diverse flora. However, it is recommended to extend the study to a higher number of patients and to evaluate all the biological parameters involved in this viral pathology after treatment with Hepatitis tiben in order to validate this study.

The authors wish to express their deep gratitude to M. COMPAORE Jean-Marie, traditional health practitioner of Burkina Faso, author of the recipe “Hepatib tiben”, for having accepted the use of his recipes for this study and his collaboration.