Chronic viral hepatitis B: evaluation of the care of patients monitored at the SMIT in Tivaouane, Sénégal

IF 1.7 Q4 INFECTIOUS DISEASES

IJID regions Pub Date : 2025-07-12 DOI:10.1016/j.ijregi.2025.100701

Agbogbenkou Tevi Dela Dem Lawson, Maimouna Sidibé, Daouda Thioub, Khadim Mbaye, Sylvie Audrey Diop

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Abstract

Objectives

Chronic hepatitis B is a liver-tropic disease caused by hepatitis B virus (HBV) with hepatitis B surface antigen persisting beyond 6 months. According to a 2024 report by the Pasteur Institute, the prevalence of chronic HBV infection in Senegal is alarming, ranking among the highest in the world, between 10 and 17%. Senegal currently does not have a standardized algorithm for the management of chronic hepatitis B. Since 2017, the European Association for the Study of the Liver (EASL) has proposed a new classification of chronic hepatitis B and a surveillance scheme. The objective was to evaluate the management of patients with viral hepatitis B in rural areas according to the EASL criteria.

Methods

Retrospective and prospective, descriptive study with analytical aim from March 15, 2022 to December 7, 2024, at the SMIT Mame Abdou Aziz Sy Dabakh hospital in Tivaouane. Included were patients with chronic hepatitis B who had benefited from an initial management assessment according to the criteria of the EASL. Data were captured using Kobocollect software, encoded, and analyzed using R software, V.4.4.0. Ethical considerations were respected.

Results

We collected 72 patients. The median age was 34 years (28-41), with a female predominance (56.9%). Housewives (34.7%) and teachers (16.7%) were the most represented. The notion of familial liver cancer (16.67%) was reported with 41.67% in the first degree as well as in the second degree. The discovery of HBV carriage was made during an assessment initiated by the practitioner (63.9%), prenatal assessment (19%), and during a blood donation (9.7%). Nine patients (12.51%) were symptomatic. The hepatitis B e-antigen dosage was negative in 69 patients (95.53%). The median alanine aminotransferase levels were 23.10 IU/l (16-32.25) and viral load 379.5 IU/ml (37-1562). Two hepatitis D virus/HBV co-infections were observed. Fibrosis (F0-F1) was found in 82.5% of cases, F2-F3 in 14.3%, and cirrhosis in 3.2%. Tenofovir disoproxil fumarate treatment was initiated in 10 patients (13.9%), according to the 2017 EASL guidelines. Ineligible patients (86.1%) were placed on surveillance, the rate and frequency of which depended on the initial phase. Among the patients lost to follow-up, 42 were under surveillance (67.64%) and four were under treatment (40%). Lack of treatment and high cost of care were the main reasons for exclusion from follow-up. In multivariate analysis, no factor was significantly associated with loss to follow-up.

Conclusions

Our study highlights the challenges of managing chronic viral hepatitis B in rural areas. The high cost of monitoring and the lack of treatment for the majority of patients contribute to loss of follow-up.

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慢性病毒性乙型肝炎：评估在ssamnassia， Tivaouane的SMIT监测的患者的护理

目的慢性乙型肝炎是由乙型肝炎病毒（HBV）引起的一种嗜肝性疾病，乙型肝炎表面抗原持续时间超过6个月。根据巴斯德研究所2024年的一份报告，塞内加尔的慢性乙型肝炎病毒感染率令人震惊，在世界上名列前茅，在10%至17%之间。塞内加尔目前没有慢性乙型肝炎管理的标准化算法。自2017年以来，欧洲肝脏研究协会（EASL）提出了一种新的慢性乙型肝炎分类和监测方案。目的是根据EASL标准评估农村地区病毒性乙型肝炎患者的管理。方法回顾性和前瞻性描述性研究，分析目的为2022年3月15日至2024年12月7日，在蒂瓦纳SMIT Mame Abdou Aziz Sy Dabakh医院。纳入的是根据EASL标准从初始管理评估中获益的慢性乙型肝炎患者。使用Kobocollect软件捕获数据，使用R软件V.4.4.0进行编码和分析。伦理考虑得到尊重。结果共收集患者72例。中位年龄34岁（28-41岁），以女性为主（56.9%）。家庭主妇（34.7%）和教师（16.7%）的比例最高。家族性肝癌的发生率为16.67%，其中一级和二级分别为41.67%。HBV携带者的发现是在由医生发起的评估（63.9%）、产前评估（19%）和献血期间（9.7%）发现的。有症状者9例（12.51%）。乙型肝炎e抗原剂量阴性69例（95.53%）。中位丙氨酸转氨酶水平为23.10 IU/l(16-32.25)，病毒载量为379.5 IU/ml（37-1562）。观察到2例丁型肝炎病毒/HBV合并感染。纤维化（F0-F1）占82.5%，F2-F3占14.3%，肝硬化占3.2%。根据2017年EASL指南，10名患者（13.9%）开始了富马酸替诺福韦二氧吡酯治疗。不符合条件的患者（86.1%）接受监测，监测的率和频率取决于初始阶段。失访患者中，接受监测的42例（67.64%），接受治疗的4例（40%）。缺乏治疗和护理费用高是排除随访的主要原因。在多变量分析中，没有任何因素与随访损失显著相关。结论我们的研究强调了在农村地区管理慢性乙型肝炎的挑战。对大多数患者来说，高昂的监测费用和缺乏治疗导致了随访的缺失。

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