Clinical Profile and Outcomes of HBeAg-Negative Chronic Hepatitis B in a High-Endemic African Setting: A Retrospective Cohort Study from Senegal

Abstract

Background: Chronic hepatitis B remains a major public health concern, particularly in regions of high endemicity such as sub-Saharan Africa. Among individuals with chronic hepatitis B surface antigen (HBsAg) carriage, a substantial proportion present with HBeAg-negative chronic infection, usually reflecting low-level viral replication under immune control. In Senegal, data on this clinical profile remain limited. The aim of this study was to describe the epidemiological, clinical, biological, and evolutionary characteristics of patients with HBeAg-negative chronic hepatitis B infection followed in the Hepato-Gastroenterology Department of Hospital Aristide Le Dantec. Methods: We conducted a retrospective, longitudinal study with both descriptive and analytical components over a six-year period, from January 1, 2015, to December 31, 2020. All patients followed for HBeAg-negative chronic hepatitis B infection were included. Epidemiological, clinical, biological, therapeutic, and follow-up data were collected from medical records and analyzed using SPSS version 18. Results: A total of 95 patients were included, corresponding to a hospital-based proportion of 5.65% among all patients with chronic hepatitis B followed in the department during the study period. The sex ratio was 0.38, indicating a female predominance. The mean age was 35 years (range: 19 - 59 years). Diagnosis was most frequently established during routine screening (32.7%), antenatal follow-up (28.4%), or blood donation (17.9%). Clinically, 79% of patients were asymptomatic. HBV DNA was undetectable in 9 patients. The mean viral load was 489 IU/mL (range: 26 - 1974). Liver fibrosis assessment using FibroScan performed in 43 patients showed stage F0 - F1 in all patients. A FIB-4 score greater than 1.45 was observed in 5 patients. The mean follow-up duration was 36 months (range: 12 - 82) with a loss to follow-up rate of 65.2%. Transient elevations in transaminases were observed in 9 patients (9.45%). These were attributed to herbal medicine use in 2 cases, viral reactivation in 1 case, and remained unexplained in the remaining cases. During follow-up, the mean viral load was 738 IU/mL (range: 10 - 21,500). HBV DNA became undetectable in 25 patients (26.9%). Only one case of viral reactivation was documented. FibroScan performed in 15 patients during follow-up confirmed absent or minimal fibrosis. HBsAg seroclearance occurred in 3 patients (3.2%). No cases of cirrhosis, hepatocellular carcinoma, or death were recorded. Preventive antiviral therapy was initiated in one patient receiving corticosteroids. Conclusion: In this cohort, HBeAg-negative chronic hepatitis B infection appeared relatively uncommon and was associated with a favorable medium-term outcome. However, the high rate of loss to follow-up represents a significant limitation and underscores the need for structured and sustained monitoring to prevent complications and allow early detection of potential viral reactivation.