Abstract :

Background: Hepatitis B virus (HBV) infection is the global public health problem leading to a wide spectrum of clinical presentations ranging from an asymptomatic carrier state, acute self-limiting, fulminant hepatitis, to chronic hepatitis with progression to cirrhosis and hepatocellular carcinoma (HCC). In an effort to fight HBV infection, Tanzania introduced a national infantile-pediatric HBV vaccination program in 2002 and started treatment in 2009. However, the demographic, clinical, and virological characteristics of HBV-infected patients in Tanzania have been poorly known since then. This study aimed at determining the demographic, clinical, and virological characteristics of HBV infection in HBV-infected individuals attending Bugando Medical Centre (BMC).

Methodology: A retrospective-prospective hospital-laboratory-based study involving 196 HBsAg-positive patients attending the Bugando Medical Centre-Hepatitis B Virus (BMC-HBV) clinic was conducted from May to October 2023. Whole blood, serum, and plasma were used to analysed the full blood picture (FBP), alanine amino transferase (ALT), aspartate amino transference (AST), alpha-fetoprotein (AFP), and hepatitis B viral load (HBVVL). Demographic, clinical, and some laboratory findings were extracted from medical records and analysed for demographic pattern, clinical, and virological characteristics. Antiviral eligibility and utility were analysed as per the 2015 World Health Organization (WHO) HBV prevention, care, and treatment guidelines.

Results: A total of 196 HBV-infected patients were enrolled, with a median age of 39 [32–47.5] years. The majority, 194 (99.0%), were older than 20 years. Males formed the majority 144 (73.6%) of the studied participants. Hepatitis B viral load (HBVVL) median was 979 [185-8467.5], with 81.1% being above 20,000 IU/mL HBVVL. About 55% were in an inactive phase, while 13% and 14 % had fibrosis using an APRI score > 1.5 and FIB-4 score >3.25 respectively. By using APRI/FIB-4 COMBO fibrosis was observed in 11.7% of patients. Antiviral therapy (AVT) eligibility and anti-HBV (anti-retroviral) ARV uptake were 22.5% and 6.8%, respectively, based on WHO-2015 HBV treatment guidelines.

Conclusion: The majority of HBV-infected individuals were younger than 20 years old. The WHO-2015 ARV eligibility results were in agreement with the global reports. However, ARV uptake was far below global expectations. The majority of individuals on ARV were non-eligible, which resulted in a non-significant change in liver enzymes and virological kinetics between ARV-experienced and ARV-naive individuals.