Hepatitis B testing and treatment in HIV patients in The Gambia-Compliance with international guidelines and clinical outcomes

• Published in: PloS one Vol. 12; no. 6; p. e0179025
• Main Authors: Ndow, Gibril, Gore, Mindy L, Shimakawa, Yusuke, Suso, Penda, Jatta, Abdoulie, Tamba, Saydiba, Sow, Amina, Touré-Kane, Coumba, Sadiq, Fouzia, Sabally, Saihou, Njie, Ramou, Thursz, Mark R, Lemoine, Maud
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.06.2017; Public Library of Science (PLoS)
• Subjects: Adult; Age; Analysis; Antigens; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Antiviral Agents - therapeutic use; Biology and Life Sciences; Cancer; Care and treatment; Clinical outcomes; Coinfection - diagnosis; Complications; Cross-Sectional Studies; Deoxyribonucleic acid; Diagnosis; Disease control; Disease prevention; DNA; Drug therapy; Family medical history; Feasibility studies; Female; Fibrosis; Gambia; Guidelines; Health aspects; Health screening; Hepatitis; Hepatitis B; Hepatitis B - diagnosis; Hepatitis B - drug therapy; Hepatitis B - epidemiology; Hepatitis B surface antigen; HIV; HIV Infections - drug therapy; HIV patients; Hospitals; Human health and pathology; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Intervention; Lamivudine; Lamivudine - therapeutic use; Life Sciences; Liver; Liver diseases; Male; Mass Screening - statistics & numerical data; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Mortality; Patient compliance; Patients; People and Places; Practice guidelines (Medicine); Practice Guidelines as Topic; Risk assessment; Screening; Sex; Surgery; Tenofovir; Tenofovir - therapeutic use; Treatment Outcome; Young Adult; Africa; France; HIV infections; HIV; Gambia; Liver fibrosis; Hepatitis B virus; Co-infections; HIV diagnosis and management; Hepatitis B
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0179025

Compliance with WHO guidelines on HBV screening and treatment in HIV-coinfected patients is often challenging in resource limited countries and has been poorly assessed in sub-Saharan Africa. Between 2015 and 2016, we assessed physician's compliance with WHO guidelines on HIV-HBV coinfection in the largest HIV clinic in The Gambia, and the hepatic outcomes in HIV-HBV coinfected patients as compared to randomly selected HIV-monoinfected controls. 870 HIV-infected patients regularly seen in this clinic agreed to participate in our study. Only 187 (21.5%, 95% CI 18.8-24.3) had previously been screened for HBsAg, 23 (12.3%, 95% CI 8.0-17.9) were positive of whom none had liver assessment and only 6 (26.1%) had received Tenofovir. Our HBV testing intervention was accepted by all participants and found 94/870 (10.8%, 95% CI 8.8-13.1) positive, 78 of whom underwent full liver assessment along with 40 HBsAg-negative controls. At the time of liver assessment, 61/78 (78.2%) HIV-HBV coinfected patients received ART with 7 (11.5%) on Tenofovir and 54 (88.5%) on Lamivudine alone. HIV-HBV coinfected patients had higher APRI score compared to controls (0.58 vs 0.42, p = 0.002). HBV DNA was detectable in 52/53 (98.1%) coinfected patients with 14/53 (26.4%) having HBV DNA >20,000 IU/L. 10/12 (83.3%) had at least one detectable 3TC-associated HBV resistance, which tended to be associated with increase in liver fibrosis after adjusting for age and sex (p = 0.05). Compliance with HBV testing and treatment guidelines is poor in this Gambian HIV programme putting coinfected patients at risk of liver complications. However, the excellent uptake of HBV screening and linkage to care in our study suggests feasible improvements.