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Updated: Nov 7, 2025
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Prevalence of chronic hepatitis B phases in Eritrean patients: a laboratory-based cross-sectional study
Mohammed Elfatih Hamida1, Saud Mohammed Raja2, Yemane Seyoum2
1Department of Microbiology, Orotta College of Medicine and Health Sciences (OCMHS), Asmara, Eritrea. mohelfatih77@gmail.com.
Insights
Most Eritrean chronic hepatitis B (CHB) patients are in the inactive phase, with few eligible for treatment. Periodic liver assessment is advised for those over 40, and local AASLD guideline adaptation is recommended.
Area of Science:
- Hepatology
- Virology
- Public Health
Background:
- Understanding the natural history of chronic hepatitis B (CHB) is crucial for patient management and prognosis.
- Determining the prevalence of CHB infection phases in Eritrea and treatment eligibility by AASLD guidelines is important.
Purpose of the Study:
- To ascertain the distribution of CHB infection phases among Eritrean patients.
- To identify the proportion of CHB patients eligible for treatment based on 2018 AASLD guidelines.
Main Methods:
- A cross-sectional study of 293 CHB patients (Jan 2017-Feb 2019).
- Classification into immune-tolerant, immune-active, and inactive CHB phases using serological markers (HBsAg, anti-HBc, HBeAg, anti-HBe), ALT, and HBV DNA.
- Application of 2018 AASLD guidelines for treatment eligibility assessment.
Main Results:
- The majority of patients (79.2%) were in the inactive CHB phase, with 19.8% in the immune-active phase and 1.0% in the immune-tolerant phase.
- Most patients (93%) were HBeAg-negative.
- Only 1.7% of patients met the 2018 AASLD criteria for current treatment eligibility.
Conclusions:
- Eritrean CHB patients are predominantly in the inactive phase, with low treatment eligibility.
- Periodic liver function and severity assessments are recommended for CHB patients over 40.
- The study supports adapting AASLD guidelines for local settings in Eritrea, noting the success of HBV vaccination programs.
Background:
Understanding the natural history of chronic hepatitis B (CHB) virus infection is important for determining optimal management and predicting prognosis in patients. The aim of this study was to determine the prevalence of different phases of CHB infection among Eritrean patients and to identify the proportion of patients who are eligible for treatment according to the latest American Association for the Study of Liver Diseases (AASLD) guidelines.
Methods:
This cross-sectional study enrolled 293 CHB patients (213 males and 80 females) between Jan 2017 and Feb 2019. The patients were classified into immune-tolerant, immune-active, and inactive CHB phases of the infection, which is based on the results of Hepatitis B virus (HBV) serological panel (HBsAg, anti-HBc total, HBeAg, and anti-HBe), ALT levels, and HBV DNA viral load. The 2018 AASLD guidelines were also used to identify patients who needed treatment.
Results:
The mean age of the patients was 41.66 ± 13.84 years. Of these, 3 (1.0%) were at the immune tolerant phase, 58 (19.8%) at the immune-active CHB phase, and 232 (79.2%) at the inactive CHB phase. As most subjects (93%) were HBeAg-negative, based on AASLD guidelines, only 5 (1.7%) were currently eligible for treatment.
Conclusions:
Our data show that CHB patients in Eritrea were predominantly in the inactive CHB phase. Although initiating antiviral therapy is not recommended in these patients, periodic assessment of liver function and disease severity should be considered in patients older than 40 years. The immune-tolerant phase had the fewest patients, most of whom were aged above 20 years, attesting to the success of incorporating HBV vaccine in the national childhood immunization program since 2002. Our study shows that adopting AASLD treatment guidelines with adjustments to suit the local setting is a suitable option in the management of Eritrean CHB patients.
