Five-year results of a treatment program for chronic hepatitis B in Ethiopia

BACKGROUND

In sub-Saharan Africa, less than 1% of treatment-eligible chronic hepatitis B (CHB) patients receive antiviral therapy. Experiences from local CHB programs are needed to inform treatment guidelines and policies on the continent. Here, we present 5-year results from one of the first large-scale CHB treatment programs in sub-Saharan Africa.

METHODS

Adults with CHB were enrolled in a pilot treatment program in Addis Ababa, Ethiopia, in 2015. Liver enzymes, viral markers, and transient elastography were assessed at baseline and thereafter at 6-month intervals. Tenofovir disoproxil fumarate was initiated based on the European Association for the Study of the Liver (EASL) criteria, with some modifications. Survival analysis was performed using the Kaplan-Meier method.

RESULTS

In total, 1303 patients were included in the program, of whom 291 (22.3%) started antiviral therapy within the initial 5 years of follow-up. Among patients on treatment, estimated 5-year hepatocellular carcinoma-free survival was 99.0% in patients without cirrhosis at baseline, compared to 88.8% in patients with compensated cirrhosis, and 54.2% in patients with decompensated cirrhosis (p < 0.001). The risk of death was significantly higher in patients with decompensated cirrhosis at baseline (adjusted hazard ratio 44.6, 95% confidence interval 6.1-328.1) and in patients older than 40 years (adjusted hazard ratio 3.7, 95% confidence interval 1.6-8.5). Liver stiffness declined significantly after treatment initiation; the median change from baseline after 1, 3, and 5 years of treatment was - 4.0 kPa, - 5.2 kPa, and - 5.6 kPa, respectively.

CONCLUSIONS

This pilot program demonstrates the long-term benefits of CHB therapy in a resource-limited setting. The high mortality in patients with cirrhosis underscores the need for earlier detection of CHB and timely initiation of antiviral treatment in sub-Saharan Africa.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.gov (NCT02344498) on January 26, 2015.

Oral administration of a water extract of Phytolacca dodecandra l'herit in mice--effects on reproduction

Experiments were conducted to determine whether oral administration of a water extract of P. dodecandra had significant effects on reproduction in mice. The work is based on earlier reports in this journal that butanol extracts of the berries of this plant had spermatocidal properties in vitro and blastocidal activity when injected directly into the uterus of rabbits. The extract was supplied to groups of mice in the drinking water at predetermined concentrations (range 0-250 mg per liter) and treatment intervals (continuous and monthly). An analysis of variance was performed on the results of the following variables for all the groups: mean number of females giving birth in each treatment group, mean number of days taken to give birth, mean number of young born per group, and mean number of young surviving at four days post-parturition. The results indicated that there were no significant differences (p greater than 0.05) between all the groups on all of the parameters evaluated. From the results obtained a tentative conclusion was reached that bodies of water treated with molluscicidal concentrations (approximately 50-100 mg/liter) of P. dodecandra water extract, probably do not pose a great danger to reproduction in mice within the limits of the experimental conditions described.

The erythrokinetics of Zebu cattle chronically infected with Trypanosoma congolense

The erythrokinetics of Ethiopian Zebu cattle infected with T congolense were studied at 12-16 weeks after infection using 59Fe and 51Cr-labelled red cells. The severe anaemia which developed as a result of the infectionw as found to be due principally to a massive loss of red cells from the circulation.