Treatment Penetration and Correlates of Diagnostic Parameters among Hepatitis B Seropositive Individuals in Ondo State, Nigeria

ABSTRACT

Our aim is to determine Hepatitis B Virus (HBV) infection's treatment penetration among infected patients and levels of correlation between serologic, biochemical and molecular tests. Serologic tests considered were, Hepatitis B surface Antigen (HBsAg), Hepatitis B surface Antibody (HBsAb), Hepatitis B 'e' Antigen (HBeAg), Hepatitis B core Antibody (HBcAb) and Hepatitis B 'e' Antibody (HBeAb); biochemical tests included alanine transaminase (ALT) and the molecular test was HBV viral DNA load. These parameters were considered among Hepatitis B seropositive patients so as to evaluate individual relevance of these tests to disease management in an endemic population. In this retrospective study, data of patients who attended Viral Hepatitis Clinics in University of Medical Sciences Teaching Hospital Complex, Ondo, Nigeria from 2014 to 2019 were extracted. Serological profiles (HBsAg, HBsAb, HBeAg, hepatitis B core antibody; HBcAb), antibody against HBeAg (HBeAb); biochemical markers (alanine transaminase; ALT); and HBV viral DNA loads were collated. Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 23.0. Among a total of 630 HBsAg sero-positive patients, 48 completed the three series of tests and commenced treatment; giving a treatment penetration rate of 7.6%. Among these, 28 were males and 20 were females (1.4:1) with mean age of 34years. All had detectable viral load above 20 iu/mL and were all HBcAb positive; 26 (54.2%) had viral load below 2,000 iu/mL. Among the total of 48 patients 2 were HBeAg positive while 46 were negative. Among 46 which were HBeAg seronegative, 20 (43.5%) had viral load above 2,000 iu/mL. The 2 patients with HBeAg had viral load above 20,000 iu/mL and were also positive for HBeAb. Among the 19 (39.6%) which had ALT values greater than 20iu/L, nine (47.4%) had viral load above 2,000 iu/mL, while among 29 (60.4%) with ALT below 20 iu/L, 13 (44.8%) had viral load greater than 2,000iu/L.  We concluded that wide gaps exist between HBsAg sero-positivity and treatment penetration in our environment. Neither serology, ALT nor viral loads can single handedly predict needs for patients' treatment. The presence of HBeAb was not protective against HBeAg. The need for special national hepatitis programs for adequate provision of treatment and follow-up services cannot be overemphasized.