Hépatite B Chronique à Antigène Hbe Négatif à Yaoundé, Cameroun

Firmin Ankouane, Mathurin Kowo, Oudou Njoya, Magloire Biwolé Sida, Christian Tzeuton, Elie Claude Ndjitoyap Ndam

Abstract


RÉSUMÉ
OBJECTIFS. L’hépatite B chronique à antigène HBe (AgHBe) négatif est associée à un mauvais pronostic et à un taux de réponse soutenue au traitement antiviral faible. Notre étude avait pour but de déterminer les aspects épidémiologiques de l’hépatite B chronique à AgHBe négatif à Yaoundé, centre de référence du traitement des hépatites chroniques au Cameroun.
PATIENTS ET MÉTHODES. De 2004 à 2012, 315 patients consécutifs porteurs chroniques de l’AgHBs ont été enregistrés. Les analyses sérologiques ont été effectuées en utilisant des kits commerciaux ELISA pour détecter l’AgHBs, les anti-HBc totaux, l’AgHBe, les anti-HBe, l’anti-delta et les anti-VHC. Les taux d’ADN VHB ont été mesurés par la technique COBAS Ampliprep (Roche). Les tests biochimiques pour le calcul du fibrotest/actitest ont été réalisés avec l’automate COBAS (Roche). La prévalence de l’hépatite B chronique à AgHBe négatif, les données démographiques, l’association entre le taux d’ADN VHB et les dommages hépatiques ont été explorées.
RÉSULTATS. La prévalence de l’hépatite B chronique à AgHBe négatif était de 92,1%(290/315) [IC à 95% 88,4-94,7]. Le sexe ratio H/F était de 2,8. Les transaminases ALAT étaient normales chez 67,2% (195/290) de patients. La cirrhose existait chez 6,1% (8/132). La virémie médiane était de 1140 UI/ml, 70,3% (166/236) avaient un ADN VHB ≤ 2000UI/ml et 20,3%(48/236) un ADN VHB indétectable. Aucune association statistiquement significative n’a été notée entre le taux d’ADN VHB et l’âge, le taux de transaminases ALAT ou la cirrhose.
CONCLUSION. L’hépatite B chronique à AgHBe négatif est la forme prédominante au Cameroun. Cette particularité soulève le problème de la prise en charge thérapeutique vu son mauvais pronostic.

ABSTRACT
BACKGROUND. Chronic hepatitis B e antigen-negative hepatitis is known to be related to a poor outcome and a low rate of sustained viral response on antiviral therapy. The aim of this study was to determine the epidemiological aspects of chronic hepatitis B e antigen-negative hepatitis in Yaounde, one of Cameroon’s reference treatment center for viral hepatitis.
PATIENTS AND METHODS. From 2004 to 2012, 315 consecutively confirmed cases of positive hepatitis B surface antigen (HBsAg) were recorded. Serological assays were done using commercial ELISA kits to detect HBsAg, hepatitis B core (HBc) antibodies, HBeAg, hepatitis D virus (HDV) antibodies and hepatitis C virus (HCV) antibodies. The COBAS Ampliprep (Roche) technique was used to quantify HBV DNA. Biochemical analysis to evaluate the level of liver fibrosis and activity were done using the COBAS equipment (Roche). The prevalence of hepatitis B e antigen-negative, demographic data, the association between the HBV DNA load and liver damages were analysed.
RESULTS. The prevalence of chronic hepatitis B e antigen-negative was 92.1% (290/315) [CI at 95%, 88.4 – 94.7]. The male to female was 2.8. Alanine aminotransferase was normal in 67.2% (195/290) patients. Eight out of one hundred and thirty-two (6.1%) patients had cirrhosis. The median viral load was 1140 UI/ml, 70.3% (166/236) had a HBV DNA level ≤ 2000UI/ml while it was undetectable in 20.3% (48/236) patients. There was no significant association between viral load, age, alanine aminotransferase and cirrhosis. CONCLUSION. Chronic hepatitis B e antigen-negative predominates in Cameroon. It calls for special attention in the management of chronic hepatitis B in Cameroon due to poor outcome.


Keywords


Hépatite B chronique, Prévalence, cirrhose du foie, maladies du foie, antigène HBe, ADN viral, charge virale, Cameroun Keywords: Prevalence, Liver Cirrhosis, Liver diseases, Viral Load, Hepatitis B, Hepatitis B e Antigens , Hepatitis B Surface

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