Virological Characterization of Hepatitis B Virus Infection at a Major Gastrointestinal Clinic in Accra, Ghana

Abstract

Introduction : Hepatitis B is prevalent in sub-Saharan Africa. Adverse outcomes of infection include cirrhosis and hepatocellular carcinoma with prognosis worse in endemic areas. Hepatitis B treatment guidelines recommend treatment in patients
with active chronic inflammation or liver cirrhosis to reduce risk of disease progression. However, there is as yet no national hepatitis B treatment program in Ghana. This study risk-stratifies new patients by serology and viremia at the tertiary centre in Accra.
Methods : Retrospective study of new patients referred with chronic hepatitis B at the Korle-Bu Teaching Hospital, Accra. Serologic data were obtained from medical records using standard data collection form. Means, medians, linear range (±SD) were presented for continuous variables and  frequencies for categorical variables.
Results : Overall, 387 patients with hepatitis B were reviewed. Of the 255 patients with serology, 209 (82.0%) were HBeAg-negative. Serum ALT was elevated, > 40 IU/mL, in 38.5%. HBV DNA > 2,000 IU/mL in 52.7% (n = 167). ALT > 40 IU/mL and HBV DNA > 2,000 IU/mL in 23.3% (n = 150). Patients with ALT > 40 IU/mL were more likely to have HBV DNA > 2,000 IU/ml, P=0.001. In patients with liver ultrasound (n=51), liver cirrhosis and hepatocellular carcinoma were diagnosed in 8 and 9 patients respectively.
Conclusions : Liver cirrhosis and hepatocellular carcinoma were evident at presentation in some patients. Furthermore, 23.3% had ALT > 40 IU/mL and HBV DNA > 2,000 IU/mL, associated with increased risk of liver-related complications. In achieving current hepatitis B guidelines, there is the need for a sustainable national treatment program for eligible patients in Ghana.