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Table of Contents
ORIGINAL ARTICLES
Year : 2022  |  Volume : 14  |  Issue : 1  |  Page : 29-32

HBsAg Loss among a Cohort of Nigerians with chronic hepatitis B virus infection


1 Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun, State, Nigeria
2 Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun, State, Nigeria

Date of Submission19-Apr-2022
Date of Acceptance15-Jun-2022
Date of Web Publication21-Jul-2022

Correspondence Address:
Olusegun Adekanle
Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njgh.njgh_7_22

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  Abstract 

Background: Chronic hepatitis B (CHB) virus is an infection that has lasted for 6 months or more without a complete resolution. Nigeria has a hyper-endemic CHB infection rate. There are few or no reports of HBsAg loss among Nigerians on treatment for CHB. We therefore report seven cases of CHB that cleared HBsAg with treatment from the Obafemi Awolowo University Teaching hospital Ile-Ife, Nigeria. Materials and Methods: Case records of patients that cleared HBsAg during follow-up treatment in the gastrointestinal clinic were reviewed and information on biodata, prescribed medication, duration of treatment, and hepatitis B viral quantity among others were extracted and presented in a table and as percentages. Results: Seven patients had lost HBsAg among our treated cases; they were five males and two females. Duration of treatment ranged from 6 months to about 4 years. All were HBeAg negative. Serum HBV-DNA ranged from 22 to 3.2 x 106 IU/mL at the start and was not detectable at the end of treatment. Anti-HBs were detectable in three cases. Serum alanine aminotransferase (ALT) reduced significantly in five cases. Tenofovir disoproxil fumarate (TDF) was prescribed in four cases, one had PEGylated interferon (PegIFN), and two other cases switched between TDF and PegIFN. Conclusion: Antivirals for CHB are effective and HBsAg loss may follow undetectable viral suppression. Antivirals are therefore beneficial among Nigerians who are infected with CHB.

Keywords: Chronic hepatitis B, HBsAg loss, Nigerians, treatment


How to cite this article:
Adekanle O, Ijarotimi O, Umenze IK, Ndububa DA. HBsAg Loss among a Cohort of Nigerians with chronic hepatitis B virus infection. Niger J Gastroenterol Hepatol 2022;14:29-32

How to cite this URL:
Adekanle O, Ijarotimi O, Umenze IK, Ndububa DA. HBsAg Loss among a Cohort of Nigerians with chronic hepatitis B virus infection. Niger J Gastroenterol Hepatol [serial online] 2022 [cited 2022 Aug 19];14:29-32. Available from: https://www.njghonweb.org/text.asp?2022/14/1/29/351555




  Introduction Top


Chronic hepatitis B virus (CHB) is an infection that has lasted for 6 months or more without a complete resolution.[1] The hepatitis B infection rate in Nigeria is hyper-endemic, but the prevalence seems to be reducing.[2] The current prevalence rate according to the Federal Ministry of Health statistics in Nigeria is 8.1%[3] Medications that are available for the treatment of CHB in Nigeria include injectable like PEGylated interferon and oral nucleos(t)ide analogs such as lamivudine (LAM), Tenofovir disoproxil fumarate (TDF), Entecavir, and recently Tenofovir alafenamide (TAF). Most antivirals have been in the Nigerian market for more than a decade except TAF which was introduced into the Nigerian market in the last 3 years. The World Health Organization (WHO) has mandated member nations to eliminate viral hepatitis including hepatitis B by the year 2030.[4] Therefore, patients are put on treatment at various healthcare levels in Nigeria, with an increasing number of cases being put on medications year after year to achieve the WHO target. Despite the number of people on treatment, there has been little or no report from Nigeria on the success or otherwise of these medications. On the contrary, reports from the West and Asia have shown that patients who were treated with oral antiviral medications had loss of HBsAg ranging from between 3.5% and 5%. Two reports showed that older age at commencement of treatment and low HBsAg titer or the inactive stage of CHB were strongly associated with HBsAg loss.[5],[6] In another report, patients that received Entecavir for 96 weeks and 24 weeks off treatment, had loss of HBsAg in 5.1% of cases, especially among those with HBV genotypes A or C and those with low HBV-DNA quantity below 60 IU/mL.[7] Also, HBV-DNA viral suppression to below 29 IU/mL in HBV genotypes A or D and HBV infection of less than 4 years were associated with HBsAg clearance.[8] Moreover, patients who received Tenofovir and PEGylated interferon combination resulted in loss of HBsAg than those who received either medication alone.[9] In addition, extended therapy with PEGylated interferon beyond 48 weeks resulted in additional loss of HBsAg in 30.0% of those taking treatment for up to 72–96 weeks.[10] We therefore report seven patients that cleared HBsAg after medication among Nigerians.


  Materials and methods Top


The case records of patients with CHB who cleared HBsAg among our treated cases in the gastrointestinal clinic of the Obafemi Awolowo University Teaching hospital, Ile-Ife while on follow-up consecutively from the year 1999 to 2021 were reviewed. Information retrieved included biodata of the cases, treatment duration, medication (s) prescribed, and their durations. The hepatitis B viral quantity (HBV-DNA), serum alanine aminotransferase (ALT) at the beginning and end of treatment, liver ultrasound scan and the liver biopsy report. Other test results retrieved included the HBeAg and anti-HBe, and antibody to hepatitis C virus and HIV at diagnosis as well as the antibody to the surface antigen (anti-HBs) assayed by the Roche diagnostic method using the COBAS E411 analyzer that employs electro-chemiluminescence (ECS) technology at the end of patients’ treatment. Information extracted was presented in a table for each case. Simple statistical analysis was done, and categorical variables were presented as percentages, whereas the continuous variable of age was summarized as mean ± standard deviation (SD).


  Results Top


A total of seven cases had cleared their HBsAg. They were five males and two females. Age range for the cases was 30–44 years with a mean ± SD of 36.0 ± 5.9 years at time of diagnosis and commencement of treatment. The most prescribed single medication was Tenofovir (TDF) in 4/7 (57.1%) cases. One case had PEGylated interferon, whereas two other patients that did not clear HBsAg with oral nucleos(t)ide and a previous Interferon-2a (Roferon-A) treatment were switched to PEGylated interferon 2/7(28.5%). However, one of the patients who switched to PEGylated interferon continued with TDF on his own until HBsAg loss. HBV-DNA quantity was between 22 and 3 x 106 IU/mL at start of therapy in all the cases and was not detectable at the completion of therapy. Liver ultrasound parenchymal echotexture was coarse in two cases 2/7(28.55) and was normal in the rest. Liver biopsy was done in 5/7 (71.4%) and showed significant liver disease in two cases. All cases were HBeAg negative. Five cases (71.4%) had a significant reduction in the ALT level at the completion of therapy, whereas three cases (42.9%) developed anti-HBs at the end of treatment. All cases were Hepatitis C and HIV negative [Table 1].
Table 1: Profile of cases that cleared HBsAg after treatment

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  Discussion Top


The cases showed that HBsAg loss is possible with both oral and injectable medications among Nigerians with CHB. Many reports from the West and Asia have shown that HBV-DNA suppression was important for HBsAg clearance. The cases reported in this cohort agreed with this finding, HBV viral quantity was not detectable in all the cases before HBsAg loss.[7],[8] The duration of active treatment for most of the cases was between 6 months to close to 4 years, even though one case was followed up for about 18 years. This observation is close to the to 5 years reported from Asia and other western nations that resulted in 5% loss of HBsAg among treated cases.[7] Some of our reported cases received two medications, injectable and oral before they could clear HBsAg. Two patients were switched to PEGylated interferon after using oral medication for some years, however, one of those switched to PEGylated interferon refused to stop his oral TDF, and both still cleared HBsAg. This showed that either a switch medication or combination is effective as has been reported from the West.[9] Patients that failed PEGylated interferon after a sustained virological response (SVR) are switched to oral nucleos(t)ide when HBV viral quantity rises to or above 2000 IU/ml. Three of the cases had a positive anti-HBs test which is evidence of long-lasting immunity to HBV infection. The HBsAg loss occurred in cases with normal and abnormal ultrasound scans and those with histology evidence of significant fibrosis and necroinflammation. This shows that liver disease stage may not be a criterion for HBsAg loss. In reports from other centers, HBsAg loss has been reported in patients with genotypes A, B, and C; this may also be possible in patients with genotype E, because the dominant HBV type in Nigeria is genotype E and it is possible that many of the cases had HBV genotype E.[10],[11]

In conclusion, HBsAg loss occurs among Nigerians with CHB treated with antivirals, both immune modulators as well as nucleos(t)ide analog medications. Liver disease severity does not appear to play any role, HBsAg, loss usually follows a prolonged HBV viral suppression. Antivirals are therefore beneficial among Nigerians infected with CHB.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bojuwoye BJ Chronic liver diseases in Nigeria: An overview. Dokita 1996;23:1-4.  Back to cited text no. 1
    
2.
Musa BM, Bussell S, Borodo MM, Samaila AA, Femi OL Prevalence of hepatitis B infection in Nigeria, 2000–2013: A systematic review and meta-analysis. Niger J Clin Pract 2015;18:163-72.  Back to cited text no. 2
    
3.
National Bureau of Statistics. Nigeria HIV-AIDS indicator and impact survey (NAIIS) 2018; September 3, 2021.  Back to cited text no. 3
    
4.
World Health Organization. Combating Hepatitis B and C to Reach Elimination by 2030, Advocacy Brief. Geneva, Switzerland: WHO; 2016.  Back to cited text no. 4
    
5.
Kobayashi M, Suzuki F, Akuta N, Hosaka T, Sezaki H, Yatsuji H, et al. Loss of hepatitis B surface antigen from the serum of patients with chronic hepatitis treated with lamivudine. J Med Virol 2007; 79:1472-7.  Back to cited text no. 5
    
6.
Habersetzer F, Moenne-Loccoz R, Meyer N, Schvoerer E, Simo-Noumbissie P, Dritsas S, et al. Loss of hepatitis B surface antigen in a real-life clinical cohort of patients with chronic hepatitis B virus infection. Liver Int 2015;35:130-9.  Back to cited text no. 6
    
7.
Gish RG, Chang TT, Lai CL, de Man R, Gadano A, Poordad F, et al. Loss of HBsAg antigen during treatment with entecavir or lamivudine in nucleoside-naïve HBeAg-positive patients with chronic hepatitis B. J Viral Hepat 2010;17:16-22.  Back to cited text no. 7
    
8.
Marcellin P, Buti M, Krastev Z, de Man RA, Zeuzem S, Lou L, et al. Kinetics of hepatitis B surface antigen loss in patients with HBeAg-positive chronic hepatitis B treated with tenofovir disoproxil fumarate. J Hepatol 2014;61:1228-37.  Back to cited text no. 8
    
9.
Marcellin P, Ahn SH, Ma X, Caruntu FA, Tak WY, Elkashab M, et al; Study 149 Investigators. Combination of tenofovir disoproxil fumarate and peginterferon α-2a increases loss of hepatitis B surface antigen in patients with chronic hepatitis B. Gastroenterology 2016;150:134-44.e10.  Back to cited text no. 9
    
10.
Li MH, Zhang L, Qu XJ, Lu Y, Shen G, Wu SL, et al. Kinetics of hepatitis B surface antigen level in chronic hepatitis B patients who achieved hepatitis B surface antigen loss during pegylated interferon alpha-2a treatment. Chin Med J (Engl) 2017;130:559-65.  Back to cited text no. 10
    
11.
Oluyinka AA, Tong HV, Bui Tiens S, Fagbami AH, Adekanle O, Ojurongbe O, et al. Occult hepatitis B virus infection in Nigerian blood donors and hepatitis B virus transmission risks. PLoS One 2015;10(7):e0131912.  Back to cited text no. 11
    



 
 
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