Browsing by Author "Beloukas, Apostolos"

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    Liver Fibrosis by Transient Elastography and Virologic Outcomes After Introduction of Tenofovir in Lamivudine-Experienced Adults With HIV and Hepatitis B Virus Coinfection in Ghana
    (Oxford University Press, 2015-05-28) Stockdale, Alexander J.; Phillips, Richard Odame; Beloukas, Apostolos; Appiah, Lambert Tetteh; Chadwick, David; et. al
    Background. Antiretroviral treatment (ART) programs in sub-Saharan Africa have for many years included lamivudine as the sole hepatitis B virus (HBV) inhibitor. Long-term outcomes and the effects of introducing tenofovir as part of ART in these populations have not been characterized. Methods. The study comprised a cross-sectional analysis of 106 human immunodeficiency virus (HIV)/HBV– coinfected subjects maintained on lamivudine, as well as a prospective analysis of 76 lamivudine-experienced subjects who introduced tenofovir. Patients underwent assessment of liver fibrosis by transient elastography (TE) and testing to characterize HIV type 1 (HIV-1) and HBV replication. Results. After a median of 45 months of lamivudine treatment, HIV-1 RNA and HBV DNA were detectable in 35 of 106 (33.0%) and 54 of 106 (50.9%) subjects, respectively, with corresponding drug resistance rates of 17 of 106 (16.0%) and 31 of 106 (29.2%), respectively. Median TE values were 5.7 kPa (interquartile range, 4.7–7.2 kPa) and independently associated with HBV DNA load, aspartate aminotransferase levels, and platelet counts; 13 of 106 (12.3%) subjects had TE measurements >9.4 kPa. Twelve months after the first assessment, and a median of 7.8 months after introducing tenofovir, HBV DNA levels declined by a mean of 1.5 log10 IU/mL (P < .001). TE values changed by a mean of −0.2 kPa (P = .097), and declined significantly in subjects who had pretenofovir HBV DNA levels >2000 IU/mL (mean, −0.8 kPa; P = .048) or TE values >7.6 kPa (mean, −1.2 kPa; P = .021). HIV-1 RNA detection rates remained unchanged. Conclusions. A proportion of HIV/HBV-coinfected patients on long-term lamivudine-containing ART had poor HIV and HBV suppression, drug resistance, and TE values indicative of advanced liver fibrosis. Tenofovir improved HBV control and reduced liver stiffness in subjects with high HBV DNA load and TE values.
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    Long-term virological outcomes of replacing zidovudine or stavudine with tenofovir in the absence of routine virological monitoring in Kumasi, Ghana
    (Journal of the International AIDS Society, 2016) Phillips, Richard Odame; Smith, Colette; Stockdale, Alexander; Villa, Giovanni; Beloukas, Apostolos; et. al
    Whilst access to ART is successfully expanding in Africa, long-term outcomes remain poorly investigated. This study addressed the outcomes of introducing tenofovir (TDF) in place of zidovudine (ZDV) or stavudine (d4T) among Ghanaian adults receiving HIV care in the absence of routine virological monitoring and determined the associated clinical and psychosocial dimensions.
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    Prevalence of hepatitis D virus infection in sub-Saharan Africa: a systematic review and meta-analysis
    (Elsevier Ltd, 2017-10) Stockdale, Alexander J; Chaponda, Mas; Beloukas, Apostolos; Phillips, Richard Odame; Matthews, Philippa C; et. al
    Background Hepatitis D virus (also known as hepatitis delta virus) can establish a persistent infection in people with chronic hepatitis B, leading to accelerated progression of liver disease. In sub-Saharan Africa, where HBsAg prevalence is higher than 8%, hepatitis D virus might represent an important additive cause of chronic liver disease. We aimed to establish the prevalence of hepatitis D virus among HBsAg-positive populations in sub-Saharan Africa. Methods We systematically reviewed studies of hepatitis D virus prevalence among HBsAg-positive populations in sub-Saharan Africa. We searched PubMed, Embase, and Scopus for papers published between Jan 1, 1995, and Aug 30, 2016, in which patient selection criteria and geographical setting were described. Search strings included sub- Saharan Africa, the countries therein, and permutations of hepatitis D virus. Cohort data were also added from HIVpositive populations in Malawi and Ghana. Populations undergoing assessment in liver disease clinics and those sampled from other populations (defined as general populations) were analysed. We did a meta-analysis with a DerSimonian-Laird random-effects model to calculate a pooled estimate of hepatitis D virus seroprevalence. Findings Of 374 studies identified by our search, 30 were included in our study, only eight of which included detection of hepatitis D virus RNA among anti-hepatitis D virus seropositive participants. In west Africa, the pooled seroprevalence of hepatitis D virus was 7·33% (95% CI 3·55–12·20) in general populations and 9·57% (2·31–20·43) in liver-disease populations. In central Africa, seroprevalence was 25·64% (12·09–42·00) in general populations and 37·77% (12·13–67·54) in liver-disease populations. In east and southern Africa, seroprevalence was 0·05% (0·00–1·78) in general populations. The odds ratio for anti-hepatitis D virus detection among HBsAg-positive patients with liver fibrosis or hepatocellular carcinoma was 5·24 (95% CI 2·74–10·01; p<0·0001) relative to asymptomatic controls. Interpretation Findings suggest localised clusters of hepatitis D virus endemicity across sub-Saharan Africa. Epidemiological data are needed from southern and east Africa, and from patients with established liver disease. Further studies should aim to define the reliability of hepatitis D virus testing methods, identify risk factors for transmission, and characterise the natural history of the infection in the region. Funding Wellcome Trust, Royal Society. Copyright © The Author(s). Published by Elsevier Ltd. This is an