Contributors: Imperial College London; Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology; Pasteur-Cnam Risques infectieux et émergents (PACRI); Institut Pasteur Paris -Conservatoire National des Arts et Métiers CNAM (CNAM)-Institut Pasteur Paris -Conservatoire National des Arts et Métiers CNAM (CNAM); Medical Research Council Unit The Gambia (MRC); Université Cheikh Anta Diop Dakar, Sénégal (UCAD); Hands On Care Gambia (HOC); This work was supported by a Wellcome Trust-Imperial College Institutional Strategic Support Fund (ISSF) fellowship awarded to GN. Additional funding was provided by the Wellcome Trust-Imperial College Centre for Global Health Research (GN), the NIHR Imperial Biomedical Research Centre (MRT), and the EU 7th Framework Programme (FP7-AFRICA-2010, Collaborative Project PROLIFICA, Grant Nr. 265994). MLG is supported by a Wellcome Trust grant (award number 104771/Z/14/Z awarded to Dr Marcus Dorner). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of this manuscript.; We thank the Medical Research Council Unit The Gambia, the Hands on Care HIV clinic and the Wellcome Trust-Imperial College Centre for Global Health Research for supporting this study. We are grateful to Professor Simon Taylor-Robinson for his continuous support all through the project, and Dr Marcus Dorner and his team for their advice and help with the molecular virology work. We thank all study participants, the PROLIFICA Gambia team, and the MRC data management unit. Lastly, we are grateful for the administrative and logistical support from Dr Peter Norsworthy, Dawn Campbell, Kimberley Trim, Susan Farrell, Mavis Foster-Nyarko and Amie Ceesay.; European Project: 265994,EC:FP7:HEALTH,FP7-AFRICA-2010,PROLIFICA(2011)
نبذة مختصرة : International audience ; BACKGROUND: Compliance with WHO guidelines on HBV screening and treatment in HIV-coinfected patients is often challenging in resource limited countries and has been poorly assessed in sub-Saharan Africa. ; METHODS: Between 2015 and 2016, we assessed physician's compliance with WHO guidelines on HIV-HBV coinfection in the largest HIV clinic in The Gambia, and the hepatic outcomes in HIV-HBV coinfected patients as compared to randomly selected HIV-monoinfected controls. ; RESULTS: 870 HIV-infected patients regularly seen in this clinic agreed to participate in our study. Only 187 (21.5%, 95% CI 18.8-24.3) had previously been screened for HBsAg, 23 (12.3%, 95% CI 8.0-17.9) were positive of whom none had liver assessment and only 6 (26.1%) had received Tenofovir. Our HBV testing intervention was accepted by all participants and found 94/870 (10.8%, 95% CI 8.8-13.1) positive, 78 of whom underwent full liver assessment along with 40 HBsAg-negative controls. At the time of liver assessment, 61/78 (78.2%) HIV-HBV coinfected patients received ART with 7 (11.5%) on Tenofovir and 54 (88.5%) on Lamivudine alone. HIV-HBV coinfected patients had higher APRI score compared to controls (0.58 vs 0.42, p = 0.002). HBV DNA was detectable in 52/53 (98.1%) coinfected patients with 14/53 (26.4%) having HBV DNA >20,000 IU/L. 10/12 (83.3%) had at least one detectable 3TC-associated HBV resistance, which tended to be associated with increase in liver fibrosis after adjusting for age and sex (p = 0.05). ; CONCLUSIONS: Compliance with HBV testing and treatment guidelines is poor in this Gambian HIV programme putting coinfected patients at risk of liver complications. However, the excellent uptake of HBV screening and linkage to care in our study suggests feasible improvements.
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