Contributors: London School of Hygiene & Tropical Medicine Banjul, The Gambia; Imperial College London; Institut Mondor de Recherche Biomédicale (IMRB); Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12); Service d'Hépatologie, Hôpital Henri Mondor, AP-HP, Créteil, France.; Hôpital Henri Mondor; Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology; Université Paris Cité (UPCité)-Pasteur-Cnam Risques infectieux et émergents (PACRI); Institut Pasteur Paris (IP)-Conservatoire National des Arts et Métiers CNAM (CNAM)-Université Paris Cité (UPCité)-Institut Pasteur Paris (IP)-Conservatoire National des Arts et Métiers CNAM (CNAM); Edward Francis Small Teaching Hospital Banjul, Gambia (EFSTH); Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL); Centre Léon Bérard Lyon -Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS); Centre International de Recherche contre le Cancer - International Agency for Research on Cancer (CIRC - IARC); Organisation Mondiale de la Santé / World Health Organization Office Genève, Suisse (OMS / WHO); We thank the Gambian Ministry of Health and the Medical Research Council (MRC) Unit The Gambia at London School of Hygiene & Tropical Medicine for hosting and supporting the study, Gilead Sciences for providing treatment, and the European Commission’s Seventh Framework Program (grant 265994) and the MRC UK (New Investigator Research Grant; reference MR/R011117/1) for funding our research programme.; European Project: 265994,EC:FP7:HEALTH,FP7-AFRICA-2010,PROLIFICA(2011)
نبذة مختصرة : International audience ; Background: Chronic liver disease is a major cause of premature death in sub-Saharan Africa. Efficacy of antiviral therapy among patients with hepatitis B virus (HBV)-related cirrhosis is not well established in Africa. We described the clinical characteristics and outcomes of patients with cirrhosis and hepatocellular carcinoma in The Gambia and assessed the impact of tenofovir disoproxil fumarate (TDF) on survival of HBV-infected patients with cirrhosis.Methods: In this prospective cohort study, we followed up adults who were consecutively diagnosed with cirrhosis or hepatocellular carcinoma between 2012 and 2015 in The Gambia, west Africa. Patients with chronic HBV infection and cirrhosis, without hepatocellular carcinoma, were offered TDF. Primary outcome was overall survival. To determine the effect of TDF on survival, we performed a Cox proportional hazard regression model with inverse probability of treatment weighting (IPTW) based on propensity score.Findings: Of 529 patients enrolled in this study, 336 patients (252 with hepatocellular carcinoma and 84 with cirrhosis) were analysed. Patients were predominantly male (253 [75%] men and 83 [25%] women), with a median age of 42 years (IQR 33-55). 276 (84%) of 327 of patients with data were positive for HBV biomarkers, 31 (10%) of 311 were positive for hepatitis C virus antibodies, and 22 (10%) of 223 were positive for hepatitis D virus antibodies. 64% of patients with hepatocellular carcinoma had multifocal tumour, with a median size of 7·5 cm (IQR 5·4-10·8). 173 patients with hepatocellular carcinoma and 70 patients with cirrhosis were included in the survival analysis. Median survival was 1·5 months (95% CI 1·1-2·0) in patients with hepatocellular carcinoma and 17·1 months (11·2-24·0) in patients with cirrhosis (log-rank p<0·0001). In patients with hepatocellular carcinoma, ascites (hazard ratio [HR] 1·78, 95% CI 1·21-2·60), partial or complete portal thrombosis (HR 2·61, 1·58-4·30), and platelet count (HR 1·80, 1·19-2·70) were ...
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