Background: Antiviral treatment for chronic hepatitis B (CHB) is largely unavailable in sub-Saharan Africa; hence,\nlittle is known about the prognosis after initiating treatment in African CHB patients. In this study we aimed to\nassess predictors of mortality in one of the largest CHB cohorts in sub-Saharan Africa.\nMethods: Two-hundred-and-seventy-six CHB patients who started treatment with tenofovir disoproxil fumarate at a\npublic hospital in Ethiopia between March 18, 2015, and August 1, 2017, were included in this analysis. Patients\nwere followed up until October 1, 2017, and deaths were ascertained through hospital records and telephone\ninterview with relatives. Decompensated cirrhosis was defined as current or past evidence of ascites, either by\nclinical examination or by ultrasonography. Cox proportional hazard models were used to identify independent\npredictors of mortality.\nResults: Thirty-five patients (12.7%) died during follow-up, 33 of whom had decompensated cirrhosis at\nrecruitment. The median duration from start of treatment to death was 110 days (interquartile range 26-276). The\nestimated survival was 90.3, 88.2 and 86.3% at 6, 12 and 24 months of follow-up, respectively. Independent\npredictors of mortality were decompensated cirrhosis (adjusted hazard ratio [AHR] 23.68; 95% CI 3.23-173.48; p = 0.\n002), body mass index < 18.5 kg/m2 (AHR 3.65; 95% CI 1.73-7.72; p = 0.001) and older age (per 1-year increment;\nAHR 1.06; 95% CI 1.02-1.10; p = 0.007).\nConclusions: Decompensated cirrhosis, low body mass index and older age were independent predictors of\nmortality. Improved access to antiviral treatment and earlier initiation of therapy could improve the survival of\nAfrican CHB patients.
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