Chronic hepatitis B virus infection in Eastern Ethiopia: Clinical characteristics and determinants of cirrhosis

doi:10.4254/wjh.v16.i7.995

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World Journal of Hepatology

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Retrospective Cohort Study

World J Hepatol. Jul 27, 2024; 16(7): 995-1008
Published online Jul 27, 2024. doi: 10.4254/wjh.v16.i7.995

Table 1 Follow up schedule of enrolled chronic hepatitis B patients, Harar, Eastern Ethiopia

Laboratory test	On treatment	Not on treatment
After 4 weeks	CBC, ALT, AST, creatinine
Every 3 months	CBC, ALT, AST, creatinine HIV rapid test	CBC, ALT, AST, creatinine
Every 6 months	HBsAg, HBV DNA viral load, HBeAg/anti-HBe (only if HBeAg-positive previously)	HBsAg, HBV DNA viral load
Every 12 months	Abdominal ultrasound as screening for HCC

ALT: Alanine aminotransferase; anti-HBe: Hepatitis B envelope antigen antibody; AST: Aspartate aminotransferase; CBC: Complete blood count; HBeAg: Hepatitis B envelope antigen; HBsAg: Hepatitis B surface antigen; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma.

Table 2 Baseline characteristics of patients with chronic hepatitis B, by cirrhosis status, Harar, Eastern Ethiopia

Variable	All patients, n = 193	No cirrhosis, n = 133	Cirrhosis, n = 60	P value
Sex, n (%)				0.020^a
Male	132 (68.4)	84 (63.2)	48 (80.0)
Female	61 (31.6)	49 (36.8)	12 (20.0)
Age group by years, n (%)				0.852
18-25	69 (35.8)	47 (35.3)	22 (36.7)
26-35	70 (36.3)	47 (35.3)	23 (38.3)
36-45	36 (18.7)	18 (13.5)	18 (30.0)
> 45	18 (9.3)	14 (10.5)	4 (6.7)
Marital status¹, n (%)				0.597
Single	61 (31.6)	45 (33.8)	16 (26.6)
Married	123 (63.7)	81 (60.9)	42 (70.0)
Divorced/widowed	3 (1.6)	2 (1.5)	1 (1.7)
Address, n (%)				0.032^a
Harar	48 (24.9)	40 (30.0)	8 (13.3)
Dire Dawa	56 (29.0)	42 (31.6)	14 (23.3)
Oromia	71 (36.8)	34 (25.6)	37 (61.7)
Somali	18 (9.3)	17 (12.8)	1 (1.7)
Occupation², n (%)				0.009^a
Farmer	33 (17.1)	14 (10.5)	19 (31.7)
Housewife	29 (15.0)	22 (16.5)	7 (11.7)
Student	23 (11.9)	14 (10.5)	9 (15.0)
Public servant	31 (16.1)	26 (19.5)	5 (8.3)
Self employed	18 (9.3)	12 (9.0)	6 (10.0)
Others	19 (9.8)	14 (10.5)	5 (8.3)
Family history of liver cancer³, n (%)				0.569
No	183 (94.8)	125 (93.9)	58 (96.7)
Yes	9 (4.7)	7 (5.3)	2 (3.3)
Traditional herbal medicine⁴, n (%)				0.220
No	169 (87.6)	120 (90.2)	49 (81.7)
Yes	21 (10.9)	11 (8.3)	10 (16.7)
Pregnant⁵, n (%)				0.085
No	51 (89.4)	39 (86.7)	12 (100)
Yes	6 (10.5)	6 (13.3)	0
Breast feeding, n (%)				0.110
No	54 (94.7)	43 (95.6)	11 (91.7)
Yes	3 (5.3)	2 (4.4)	1 (8.3)
Alcohol abuse, n (%)				0.172
No	158 (81.9)	105 (78.9)	53 (88.3)
Yes	35 (18.1)	28 (21.1)	7 (11.7)
Khat abuse, n (%)				0.001^a
No	88 (45.6)	71 (53.4)	17 (28.3)
Yes	105 (54.4)	62 (46.6)	43 (71.7)

^aP < 0.05.

¹A total of 6 missing values, of whom 1 had cirrhosis.

²A total of 40 missing values, of whom 9 had cirrhosis.

³Data missing in 1 patient without cirrhosis.

⁴A total of 3 missing values, of whom 1 had cirrhosis.

⁵A total of 2 missing values, of whom none had cirrhosis.

Table 3 Clinical presentation of patients with chronic hepatitis B, by cirrhosis status, Harar, Eastern Ethiopia

Variables	All patients, n = 193	No cirrhosis, n = 133	Cirrhosis, n = 60	P value
Symptoms, n (%)	69 (35.8)	58 (43.6)	57 (95.0)	< 0.001^a
Jaundice	34 (17.6)	14 (10.5)	20 (33.3)	0.001^a
Abdominal pain	69 (35.8)	38 (28.6)	31 (51.7)	0.003^a
Abdominal swelling	57 (29.5)	20 (15)	37 (61.7)	< 0.001^a
Edema	32 (16.6)	6 (4.5)	26 (43.3)	< 0.001^a
Nausea/vomiting	36 (18.7)	13 (9.8)	23 (38.3)	< 0.001^a
Hematemesis	24 (12.4)	8 (6.0)	16 (26.7)	< 0.001^a
Pruritus	18 (9.3)	10 (7.5)	8 (13.3)	0.199
Muscle/joint aches	44 (22.8)	21 (15.8)	23 (38.3)	0.001^a
Confusion	13 (6.7)	9 (6.8)	4 (6.7)	0.979
Weight loss	51 (26.4)	18 (13.5)	33 (55.0)	< 0.001^a
Signs, n (%)
BMI < 18.5 kg/m²	34 (17.6)	6 (4.5)	49 (81.7)	< 0.001^a
Edema	30 (15.5)	18 (13.5)	12 (20.0)	0.033^a
Jaundice	12 (6.2)	0 (0)	12 (20.0)	< 0.001^a
Pale conjunctiva	10 (5.2)	1 (0.8)	9 (15.0)	< 0.001^a
Palmar erythema	14 (7.3)	2 (1.5)	12 (20.0)	< 0.001^a
Gynecomastia	8 (4.1)	0 (0)	8 (13.3)	0.011^a
Ascites	29 (15.0)	0 (0)	29 (48.3)	< 0.001^a
Splenomegaly	34 (17.6)	1 (0.8)	33 (55.0)	< 0.001^a
Ultrasound findings¹, n (%)
Normal liver surface	64 (47.8)	62 (80.5)	2 (3.5)	0.022^a
Mild uneven liver surface	11 (8.2)	5 (6.5)	6 (10.5)	0.478
Nodular and irregular surface	49 (36.6)	0 (0)	49 (86.0)	< 0.001^a
Other	10 (7.5)	10 (13.0)	0 (0)	0.057

^aP < 0.05.

¹A total of 59 missing values, of whom 3 patients had clinical signs of cirrhosis. BMI: Body mass index.

Table 4 Baseline biochemical, serologic, and virological data of patients with chronic hepatitis B, by cirrhosis status, Harar, Eastern Ethiopia

Variables	All patients, n = 193	No cirrhosis, n = 133	Cirrhosis, n = 60	P value
WBC as 10⁶/L	5.9 (4.1-7.7)	6.5 (4.9-7.8)	4.2 (3.0-6.3)	<0.001^a
Hemoglobin in g/L	14.7 (12.4-16.6)	15.5 (13.8-16.9)	11.8 (10.0-15.2)	< 0.001^a
Platelet count as 10⁹/L¹				<0.001^a
Median (IQR)	218 (119-294)	253 (184-344)	118 (54-180.3)
< 150, n (%)	60 (32.1)	20 (15.7)	40 (66.7)
≥ 150, n (%)	127 (67.9)	107 (84.3)	20 (33.3)
ALT (U/L)²				0.033^a
Median (IQR)	36 (23-58)	35 (22-52)	45 (27-84)
< 40, n (%)	96 (52.5)	70 (55.6)	26 (45.6)
≥ 40, n (%)	87 (47.5)	56 (44.4)	31 (54.4)
AST as IU/L³				0.016^a
Median (IQR)	40 (29-65)	36 (28-57)	51 (34-81)
< 40, n (%)	90 (49.5)	67 (53.6)	23 (40.4)
≥ 40, n (%)	92 (50.5)	58 (46.4)	34 (59.6)
Creatinine in mg/dL⁴				0.750
Median (IQR)	0.8 (0.6-1.0)	0.8 (0.6-1.0)	0.8 (0.6-1.0)
≤ 1.2, n (%)	150 (90.4)	101 (91.0)	49 (89.1)
> 1.2, n (%)	16 (9.6)	10 (9.0)	6 (10.9)
APRI score⁵				< 0.001^a
Median (IQR)	0.52 (0.29-1.35)	0.38 (0.26-0.70)	1.53 (0.66-2.84)
< 1.5, n (%)	136 (77.7)	108 (91.5)	28 (49.1)
≥ 1.5, n (%)	39 (22.3)	10 (8.5)	29 (50.9)
FIB-4 score⁶				< 0.001^a
Median (IQR)	1.06 (0.60-1.98)	0.85 (0.55-1.41)	1.93 (1.03-4.08)
≤ 3.25, n (%)	142 (82.6)	106 (90.6)	36 (65.5)
> 3.25, n (%)	30 (17.4)	11 (9.4)	19 (34.5)
HBeAg⁷				0.001^a
Negative, n (%)	105 (78.9)	80 (87.9)	25 (59.5)
Positive, n (%)	28 (21.1)	11 (12.8)	17 (40.5)
HBV viral load in IU/mL⁸				< 0.001^a
Median (IQR)	677 (135-7580)	486 (105-2863)	2843 (313-805407)
< 2000, n (%)	114 (64.4)	91 (72.2)	23 (45.1)
2000-19999, n (%)	24 (13.6)	15 (11.9)	9 (17.6)
≥ 20000, n (%)	39 (22.0)	20 (15.9)	19 (37.3)

^aP < 0.05.

¹A total of 6 missing values, of whom none had cirrhosis.

²A total of 10 missing values, of whom 3 had cirrhosis.

³A total of 11 missing values, of whom 3 had cirrhosis.

⁴A total of 27 missing values, of whom 3 had cirrhosis.

⁵A total of 18 missing values, of whom 3 had cirrhosis.

⁶A total of 21 missing values, of whom 5 had cirrhosis.

⁷A total of 60 missing values, of whom 18 had cirrhosis.

⁸A total of 16 missing values, of whom 9 had cirrhosis. ALT: Alanine aminotransferase; APRI: Aspartate aminotransferase to platelet ratio index; AST: Aspartate aminotransferase; FIB-4: Fibrosis-4; HBeAg: Hepatitis B envelope antigen; HBV: Hepatitis B virus; IQR: Interquartile range; WBC: White blood cell count.

Table 5 Factors associated with cirrhosis among patients with chronic hepatitis B, Harar, Eastern Ethiopia

Baseline variables	No cirrhosis, n = 133	Cirrhosis, n = 60	Bivariable		Multivariable
Baseline variables	No cirrhosis, n = 133	Cirrhosis, n = 60	COR (95%CI)	P value	AOR (95%CI)	P value
Sex, n (%)				0.022		0.308
Female	49 (36.8)	12 (20.0)	1		1
Male	84 (63.2)	48 (80.0)	2.33 (1.13-4.81)		1.74 (0.72-4.20)
Age group by years, n (%)				0.635
< 40	100 (75.2)	47 (78.3)	1
≥ 40	33 (24.8)	13 (26.7)	0.84 (0.40-1.74)
Alcohol abuse, n (%)				0.122
No	105 (78.9)	53 (88.3)	1
Yes	28 (21.1)	7 (11.7)	0.49 (0.20-1.21)
Khat abuse, n (%)				0.002		0.003^a
No	71 (53.4)	17 (28.3)	1		1
Yes	62 (46.6)	43 (71.7)	2.89 (1.50-5.59)		2.86 (1.44-5.68)
ALT in U/L¹, n (%)				0.213
< 40	70 (55.6)	26 (45.6)	1
≥ 40	56 (44.4)	31 (54.4)	1.49 (0.79-2.79)
AST in U/L², n (%)				0.099
< 40	67 (53.6)	23 (40.4)	1
≥ 40	58 (46.4)	34 (59.6)	1.71 (0.91-3.22)
HBeAg³, n (%)				0.007		0.022^a
Negative	80 (87.9)	25 (59.5)	1		1
Positive	11 (12.8)	17 (40.5)	3.61 (1.41-9.21)		3.81 (1.21-11.98)
HBV viral load in IU/mL⁴, n (%)				0.001		0.004^a
< 2000	91 (79.8)	23 (45.1)	1		1
≥ 2000	35 (20.2)	28 (54.9)	3.17 (1.61-6.23)		5.29 (1.72-16.33)

^aP < 0.05.

¹A total of 10 missing values, of whom 3 had cirrhosis at baseline.

²A total of 11 missing values, of whom 3 had cirrhosis at baseline.

³A total of 61 missing values, of whom 18 had cirrhosis at baseline.

⁴A total of 16 missing values, of whom 9 had cirrhosis at baseline. ALT: Alanine aminotransferase; AOR: Adjusted odds ratio; AST: Aspartate aminotransferase; CI: Confidence interval; COR: Crudes odds ratio; HBeAg: Hepatitis B envelope antigen; HBV: Hepatitis B virus.

Citation: Ismael NY, Usmael SA, Belay NB, Mekonen HD, Johannessen A, Orlien SM. Chronic hepatitis B virus infection in Eastern Ethiopia: Clinical characteristics and determinants of cirrhosis. World J Hepatol 2024; 16(7): 995-1008
URL: https://www.wjgnet.com/1948-5182/full/v16/i7/995.htm
DOI: https://dx.doi.org/10.4254/wjh.v16.i7.995