Epidemiological, Clinical and Biological Characteristics of Patients with Chronic Hepatitis B Infection Followed-Up at the University Hospital of Conakry, Guinea

Introduction: Very little information is available in Guinea on chronic hepatitis B infections. The objective of this study was to describe the epidemiological, clinical and biological features of patients who are chronic carriers of the hepatitis B virus. Patients and Methods: This is a retrospective study carried out from January 2017 to May 2020, based on the medical records of patients seen via consultation or hospitalized with a record of positive HBs antigen for more than 6 months. Clinical and paraclinical data were collected and analyzed. Results: Seven hundred and sixteen patients with a mean age of 35.6 ± 12.2 (sex ratio 2.05), were included. The HBs antigen was discovered incidentally in 36% of cases (n = 258). A history of dental care and surgical procedures was found in 46.3% (n = 290) and 21.1% (n = 138) of cases, respectively. The median value of ALAT enzymes was 34 (21 47) IU/L. HBeAg was positive in 20.8% (n = 55/265) of cases. The median B viral load was 458.5 (87 3827) IU/ml and 29% (n = 94) of patients had a viral load over 2000 IU/ml. Anti-HCV antibody was present in 10.4 % of cases (n = 39/374). HIV serology was positive in 2.7% (n = 8/298). A total of 19.4% (n = 139) of the patients had cirrhosis and 4.5% (n = 32) had hepatocellular carcinoma. Conclusion: The discovery of chronic HBs antigen was mostly fortuitous in young sexually active men, some of whom were already at the stage of cirrhosis and hepatocellular carcinoma. The best prevention strategy against this infection remains early detection and vaccination. How to cite this paper: Diallo, D., Diallo, K., Diallo, A.M., Diallo, M.M., Wann, T.A., Doumbouya, A.D., Sow, O., Baldé, Y. and Dillo, A.A.S. (2020) Epidemiological, Clinical and Biological Characteristics of Patients with Chronic Hepatitis B Infection Followed-Up at the University Hospital of Conakry, Guinea. Open Journal of Gastroenterology, 10, 256-265. https://doi.org/10.4236/ojgas.2020.1010025 Received: August 26, 2020 Accepted: October 17, 2020 Published: October 20, 2020 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access


Introduction
Hepatitis B virus (HBV) infection is a major public health condition affecting approximately 240 million people worldwide [1]. The natural history of HBV infection is variable, ranging from inactive carrier status to chronic hepatitis B, which can progress to cirrhosis and hepatocellular carcinoma [2]. Despite the existence of a preventive vaccine that is 95% effective, since 1982, hepatocellular carcinoma has been the second most deadly cancer in the world [3].
Management of chronic viral hepatitis B is costly, and prevention through screening and vaccination, either selected or generalized, remains the most effective strategy to reduce its incidence.
However, no data on a large population of chronic HBsAg carriers have been published.
The objective of this study was to describe the epidemiological, clinical and biological aspects of patients who are chronic carriers of HBsAg.

Setting
We conducted a retrospective study in the Internal Medicine Department of the Conakry University Hospital, from January 2017 to March 2020.

Population and Inclusion Criteria
We included all patients followed in ambulatory or hospitalized who had a persistent positive HBsAg for more than 6 months (confirmed by ELISA method).
Patients with a negative HBsAg control within 6 months of initial diagnosis, reclassified as acute hepatitis, were excluded from the study.

Data Collection and Variables
Data were collected from patients' medical consultation and hospitalization records on an existing survey form. The study variables were: Epidemiological (age, sex, place of residence, marital status, occupation, risk factors); Clinical (mode of discovery, history, clinical signs); Biological (haemoglobin, platelets, prothrombin levels, blood transaminases, total bilirubin, creatinine, alpha fetoprotein, albumin, HBe antigen, hepatitis C antibody, HIV antibody, viral load B, Open Journal of Gastroenterology Fibrotest fibrosis score*); ultrasound and CT scan.
The diagnosis of cirrhosis was based on clinical, ultrasound and Fibrotest* results, and that of hepatocellular carcinoma on the results of liver CT scan.
For the evaluation of hepatic fibrosis by Fibrotest* only the higher values were taken.

Ethics and Deontology
The study was approved by the Ethics Committee of the University Hospital Center of Conakry in accordance with the Declaration of Helsinki.

Statistical Analysis
Continuous variables were expressed as mean and standard deviation or median and interquartile range, while categorical variables were expressed as a percentage. Data were analyzed with EPI INFO software, version 3.5.4. Risk factors were dominated by a history of dental care in 46.3% of cases, surgery in 21.1% of cases and scarification in 9.7% as shown in Figure 1.
The biological characteristics of the sample are presented in Table 3. HBeAg

Discussion
This study involved a population of 716 patients, the majority of them were young adults between the ages of 27 -42. These results are consistent with those of most African studies [ There was a notion of alcohol consumption in 18.7% of our study population, a rate higher than the one reported in the Prolifica study but lower by half than the one reported in a study conducted in Pointe Noire, Congo [11] [15]. Since alcohol is also hepatotoxic, its consumption increase the risk of progression to hepatic complications.
The main risk factors were dental care in 46.3% and surgical procedures in 21.1%. Kpossou et al. found scarification as the main risk factor in 37.8% of cases and non-medical circumcision in 22% of cases, surgery as a risk factor was found in 19.5%.
Oumar Traoré in his dissertation had also found dental care as the first risk factor in 15.6%, followed by tattoos in 11% and surgery in 7.1% of cases.
Dental care is described as a risk factor for HBV transmission in literature, but the causes of this transmission vary from one study to another. A study published by Rimland et al. found that contamination was primarily caused by a HBVpositive dentist who did not wear gloves during the procedure [17].
According to the 1995 study by Arboleda et al., patients treated by nonprofessional dentists were 2.6 times more likely to be infected with HBV than those who received dental treatment by trained professionals [18]. However, surgery has been described as the medical profession associated with the higher risk of transmission of HBV [19]. However, this rate is comparable to those reported in the Prolifica study and in Congo with 3.3% and 1.5% respectively [11] [15]. Another study performed in Tunisia found a higher proportion (5.64%) of HBV and HIV co-infection [20].
VHB and HIV co-infection is common, due to the fact that these two viruses share the same modes of transmission and risk factors. This co-infection is a pejorative factor in the prognosis because HIV infection accelerates the progression of hepatitis B to cirrhosis and hepatocellular carcinoma.
In addition, viral C co-infection was found in 10 The progression of hepatic fibrosis to cirrhosis and hepatocellular carcinoma is due to the persistence of viral replication [23].
In this population, 166 patients were eligible for antiviral treatment according to EASL recommendations [3]. The main drug used was Tenofovir because of its high resistance barrier and its availability in our country despite its high cost.
The study had some limitations that should be pointed out. First, there was the lack of a registry in the Department to assess the weight of viral hepatitis B.
Secondly, the lack of social security coverage was a barrier to perform the biological exams required for an appropriate follow-up. Indeed, only half of the patients performed the viral load while the evaluation of fibrosis was possible in a quarter of the patients.
However, this study was a descriptive approach to chronic hepatitis B in a large hospital sample that provided insight into the epidemiological, clinical and biological characteristics in an urban setting in a low-income country.

Conclusions
Chronic viral hepatitis B predominantly affected young adult males in this study, with a fortuitous finding in most cases. The main risk factors found were dental care and surgical procedures.
The high proportion of complications, especially from cirrhosis and hepatocellular carcinoma, found immediately upon diagnosis, is an indicator of insidious evolution and delay in the diagnosis of this infection in our context. Moreover, access to diagnostic and therapeutic tools remains a major challenge. Therefore, awareness on screening and vaccination is the best strategy to reduce hepatitis B infection.

Authors' Contribution
Djenabou Diallo coordinated the study, developed the protocol, collected data, participated in data analysis, structuring and writing the article (senior editor).