Majority of the participants (70.2%) are within one SD from the mean 35.52 ± 10.34. Male patients accounted for the majority (76%).
Epidemiologically the highest percentage of the participants are from Addis Ababa followed by Oromia (57.6%, 13.9%). The remaining patients were from Amhara, Southern Nation Nationalities and Peoples Republic (SNNPR), Afar, Somalia, Harari regions and foreign countries (Somaliland, Eritrea) accounted for 8.3%, 6.9%, 2.1%, 4.2%, 4.9%, and 1.4% respectively.
The risk factor for HBV infection is unknown in majority of the patients (81.3%), while family history of liver disease was reported in (17.4%) and only 1.4% of the patients have a history of hemodialysis or blood transfusion or tattooing.
Table 1
Clinical Presentation of CHB patients at Adera Medical Center, 2022
Clinical presentation | Count (%) |
Asymptomatic | 50 (34.7%) |
Abdominal pain | 68 (47.2%) |
Nausea and/ Vomiting | 1 (0.7%) |
Jaundice | 4 (2.8%) |
Loss of appetite | 2 (1.4%) |
Weakness and fatigue | 11 (7.6%) |
Joint pain | 1 (0.7%) |
Abdominal swelling | 5 (3.5%) |
Variceal bleeding | 2 (1.4%) |
The commonest presentation of the participants is abdominal pain (47.2%) followed by weakness and fatigue (7.6%). A significant percentage (34.7%) of our patients were asymptomatic at presentation (Table 1).
Among patients with HBV, HIV and HCV coinfection were detected in 2.8% and 1.4% respectively. Majority of the patients with HBV were HbeAg negative 93.1%. Sero conversion was seen in half of the patients (52.1% HBeAb positive) while only 6.9% had HbeAg positive.
Majority (64.6%) had mild fibrosis (F0-F1) on fibro scan, suggesting a good clinical profile for half of the patient’s Nine percent of patients had moderate fibrosis while severe and advanced liver scarring accounts for 6.3%, and 4.9% respectively.
The median time to start treatment was two months from diagnosis of CHB, while most of the patients had started treatment within a year after diagnosis. The median duration of CHB treatment was 18 months. Most of the patients (43.1%) were on CHB treatment for a maximum of 1 year while 15.3% and 41.7% continued for 1–2 years and beyond 2 years. Nearly one-fifth of the patients (22%) had discontinued medication during the treatment course due to financial constraints, as all participants paid from pocket.
About 5.6% (8) of the patients on TDF treatment had a loss of HBsAg during the course of treatment (attained functional cure). Liver parameters has shown decline in the median AST and ALT level from the baseline indicating improved liver inflammation (Fig. 1).
Only twenty-nine patients have experienced an elevation of ALT above two times the ULN. Upon subsequent follow and treatment with TDF, 22 of the 29 patients (75.9%) have shown ALT level decline below 2*ULN.
During TDF treatment follow up four patients had an elevated creatinine, of which two were above the age of 60 years. Among the younger patients, one has decompensated cirrhosis, the other has no renal risk factor. The creatinine level normalized in all patients on next follow up (12th week of treatment). Only one patient didn`t tolerate TDF treatment with creatinine of 1.66. He is a 65-year-old patient with poorly controlled hypertension while on Nifedipine and with a prior history of renal mass that was surgically removed one year back. The creatinine level, in this patient, returned to normal when TDF was stopped and the patient was commenced on Entecavir.
Upon chi-square analysis of APRI improvement with baseline viral load and treatment duration, a significant association was found (p < 0.01). On further Paired T-test evaluation of baseline APRI scores, with 24-month APRI scores, there was an improvement of the mean by 0.2 (CI: 0.07–0.367; P < 0.05) (Table 2). This indicate patients with elevated APRI score are more likely to have an improvement in APRI score with longer treatment of TDF, thus a better outcome.
Table 2
Improvement in APRI score vs Baseline viral load and treatment duration
| Improvement in APRI Score from Baseline (population size(n) = 28) |
| Yes (%) | P-Value |
Age | Below 40 years | 7.1% | 0.417 |
Above 40 years | 28.6% |
Sex | Male | 35.7% | 0.524 |
Female | 0.0% |
Baseline viral load | Detectable | 32.1% | < 0.001 |
Undetectable | 3.6% |
Duration of treatment | Above 2 years | 28.6% | < 0.001 |
Below 2 years | 7.1% |