Introduction: Hepatitis B virus (HBV) infection is a major risk factor for hepatocellular carcinoma (HCC) in Africa with higher morbidity and mortality. This is in part due to disparities in access to viral treatment. We aimed to identify characteristics of individuals who were treated versus untreated for HBV in Ethiopia.
Methods: We identified HBsAg positive patients in a referral clinic in Addis Ababa, Ethiopia starting in January 2020. Clinical, laboratory and demographic data were obtained during clinic visits at baseline, 6, 12, 18 months, and recorded in REDCap. The study was approved by the institutional review board of Addis Ababa University. Analyses were performed using Chi-squared test, with p values < 0.05 considered significant.
Results: 150 HBsAg-positive patients were included: 51 treated and 99 untreated for HBV. At baseline, the treated group was more likely to be male (86%, n=44), reported higher quantity of coffee use (p< 0.05), and had higher median AST (36 vs. 27 IU), ALT (32 vs. 26 IU), and HBV DNA (25,921 vs. 389 IU/ml) compared to the untreated group. Median age was similar between both groups (35 vs 34 years). Interestingly, the treated group reported a higher level of education (56% vs 42%, p=0.19). The treated group also had higher APRI (median 0.54 vs. 0.31) and FIB4 scores (median 1.79 vs 0.85), likely relating to treatment decision. Treated individuals were more likely to have baseline ascites (p< 0.01) and abnormalities on liver ultrasound (p< 0.01). Untreated individuals reported more alcohol (5% vs 0%, p=0.1) and khat use (9% vs 0%, p=0.08). At 6 and 12 months, those treated showed a decrease in AST, ALT, FIB4 and APRI scores, with 1 case of HCC reported in that group. HCC developed in 4% (n=4) of the untreated group during the same time. At 12 months (n=55 with follow up), 44% of the untreated group had initiated treatment, and 35% had abnormal ultrasound findings. Interestingly, at 18 months, 30 patients (30%) in the untreated group followed up, whereas only 1 patient (2%) of the treated group followed up. Median APRI and FIB4 at 18 months for those untreated were 0.56 and 1.06 respectively.
Discussion: Our data from Ethiopia show that individuals on HBV treatment were more likely to be male, and have higher baseline lab findings. Those untreated showed more liver-unhealthy habits such as alcohol and khat consumption and less coffee intake. Untreated individuals developed more HCC at follow up. Interestingly, they were more likely to follow up at 18 months.
