BACKGROUND Hepatitis B is a major concern in Africa, especially in HIV-infected patients. Unfortunately, access to hepatitis B virus (HBV) testing and adequate treatment remains a challenge in the continent. We investigated HBV testing, treatment, and virologic suppression in HIV-infected patients followed up as part of Cameroon's national antiretroviral programme. METHODS A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in 19 hospitals in the Centre and Littoral regions in Cameroon. The proportions of patients tested for hepatitis B surface antigen (HBsAg) prior to the study were compared among all study hospitals using the Chi-square test. The association of individual and hospital-related characteristics with HBV testing and virologic suppression was assessed using multilevel logistic regression models. RESULTS Of 1706 patients (women 74%, median age 42 years, median time on ART 3.9 years), 302 (17.7%) had been tested for HBsAg prior to the study. The proportion of HBV-tested patients ranged from 0.8 to 72.5% according to the individual hospital (p < 0.001). HBV testing was lower in women (adjusted odds ratio [aOR] 0.64, 95% confidence interval [CI] 0.46-0.89, p = 0.010) and higher in patients who initiated ART in 2010 or later (aOR 1.66, 95% CI 1.23-2.27, p < 0.001). Of 159 HBsAg-positive patients at the time of the study (9.3%), only 97 (61.0%) received Tenofovir + Lamivudine (or Emtricitabine). Of 157 coinfected patients, 114 (72.6%) had a HBV viral load < 10 IU/mL. HBV suppression was higher in patients with a HIV viral load < 300 copies/mL (aOR 3.46, 95% CI 1.48-8.09, p = 0.004) and lower in patients with increased ALT level (aOR 0.86 per 10 IU/mL increase, 95% CI 0.75-0.97, p = 0.019). CONCLUSIONS A substantial proportion of HIV/HBV coinfected patients were at higher risk of liver disease progression. Improving the management of HBV infection in the routine healthcare setting in Africa is urgently required in order to achieve the 2030 elimination targets. Micro-elimination of HBV infection in people living with HIV could be an easier and cost-effective component than more widely scaling up HBV policies.

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在喀麦隆，HIV感染患者的乙肝测试，治疗和病毒学抑制（ANRS 12288 EVOLCAM）。

背景技术乙型肝炎是非洲的主要关注点，尤其是在HIV感染患者中。不幸的是，在非洲大陆，获得乙肝病毒（HBV）测试和适当治疗仍然是一项挑战。我们对喀麦隆国家抗逆转录病毒计划的一部分进行了调查，对接受HIV感染的患者进行了HBV检测，治疗和病毒学抑制研究。方法在喀麦隆中部和沿海地区的19家医院对接受抗逆转录病毒疗法（ART）的成年患者进行了横断面调查。使用卡方检验比较了所有研究医院中研究前接受乙型肝炎表面抗原（HBsAg）检测的患者比例。使用多级逻辑回归模型评估了个人和医院相关特征与HBV检测和病毒抑制的关联。结果在研究之前，已对1706例患者（女性74％，中位年龄42岁，平均接受ART治疗的时间为3.9年）中的302例（17.7％）进行了HBsAg检测。根据各医院的不同，经HBV检测的患者比例为0.8％至72.5％（p <0.001）。女性的HBV检测值较低（调整比值比[aOR]为0.64，95％的置信区间[CI]为0.46-0.89，p = 0.010），而在2010年或更晚开始接受抗逆转录病毒治疗的患者中则更高（aOR 1.66，95％CI为1.23 2.27，p <0.001）。在研究时，在159名HBsAg阳性患者中（9.3％），只有97名（61.0％）接受替诺福韦+拉米夫定（或恩曲他滨）治疗。在157例合并感染的患者中，有114例（72.6％）的HBV病毒载量<10 IU / mL。HIV病毒载量<300拷贝/ mL的患者，HBV抑制较高（aOR 3.46，95％CI 1.48-8.09，p = 0.004），而ALT水平升高的患者则较低（aOR 0.86，每10 IU / mL增加95） ％CI 0.75-0.97，p ＝ 0.019）。结论艾滋病毒/乙肝合并感染的患者中，很大一部分患肝病的风险更高。为了实现2030年的消灭目标，迫切需要在非洲的常规医疗机构中改善HBV感染的管理。与更广泛地扩大HBV政策相比，微量消除HIV感染者的HBV感染可能更容易且更具成本效益。95％CI 0.75-0.97，p = 0.019）。结论艾滋病毒/乙肝合并感染的患者中，很大一部分患肝病的风险更高。为了实现2030年的消灭目标，迫切需要在非洲的常规医疗机构中改善HBV感染的管理。与更广泛地扩大HBV政策相比，微量消除HIV感染者的HBV感染可能更容易且更具成本效益。95％CI 0.75-0.97，p = 0.019）。结论艾滋病毒/乙肝合并感染的患者中，很大一部分患肝病的风险更高。为了实现2030年的消灭目标，迫切需要在非洲的常规医疗机构中改善HBV感染的管理。与更广泛地扩大HBV政策相比，微量消除HIV感染者的HBV感染可能更容易且更具成本效益。