Risk Factors for Hepatic Fibrosis in Patients with Chronic Viral Hepatitis B at the Hospital National Donka CHU in Conakry

Introduction: Viral hepatitis B is a worldwide public health problem. Hepatic fibrosis is the consequence of a prolonged fibrinogenesis mechanism. It is caused by all chronic liver diseases, essentially of viral origin. The progression of fibrosis leads to cirrhosis and its complications. Fibroscan, or elastometry, is a non-invasive approach capable of assessing liver fibrosis, particularly in the management and monitoring of patients with chronic liver diseases, such as hepatitis B and C or cirrhosis. Methods: This was a prospective observational study with descriptive and analytical aims. It was carried out from 1er October 2022 to 31 July 2023, i.e. 10 months, on an outpatient basis in the hepato-gastroenterology department of the Donka National Hospital of the University Hospital of Conakry. Results: The main limitations of this study were the small sample size, the high cost of pulse elastometry, and the absence of antigenemia (quantitative HBsAg). Of the 200 patients included, 103 were men (51.5%) and 97 women (48.5%), giving a sex ratio of 1.06. The mean age was 36 years, with extremes of 18 and 77 years. The 36-49 age group was the most affected, with a frequency of 58% (n=112). Hepatic fibrosis on Fibroscan was distributed as follows: 51% (n=102) had no fibrosis or minimal fibrosis (F0F1), 30% (n=60) with moderate fibrosis (F2), 17.5% (n=35) with severe fibrosis (F3) and 2.5% (n=5) with fibrosis classified as F4. Hepatic steatosis 51% (n=102) of our patients were at stage S0, 29% (n=58) at stage S1, 12.5% (n=25) at stage S2 and 7.5% (n=15) at stage S3. In univariate analysis, the main risk factors for progression of liver fibrosis with a statistically significant association in our series were: age (p= 0.007), diabetes (p= 0.003), steatosis (p=0.001), high HBV DNA greater than or equal to 2000UI/mL (p= 0.002), HBeAg positivity (p=0.04), co-infections with hepatitis D and HIV viruses with a p-value of 0.001 and 0.020 respectively. Conclusion: Appropriate management of chronic HBV carriage can limit the risk of progression to cirrhosis and HCC, thereby reducing morbidity and mortality. The asymptomatic nature of the infection is a factor in the spread of the epidemic, and may be responsible for late diagnosis at an advanced stage of the disease. Policies must encourage widespread screening and universal vaccination against the hepatitis B virus as a matter of course, in order to reduce the risk of new infections and hence of HBV-related complications. Knowledge and identification of the risk factors for the progression of hepatic fibrosis is essential if complications are to be prevented.