Hepatitis B Virus Infection in Tanzania: Current Status and Challenges

<div>Indications for starting the treatment in patients with chronic hepatitis B virus infection [<a href="/journals/jtm/2018/4239646/#B1">1</a>]. <span class="nowrap"><svg height="15.608pt" id="M1" style="vertical-align:-3.833899pt" version="1.1" viewbox="-0.0498162 -11.7741 28.4816 15.608" width="28.4816pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M278 -108C276 -72 276 -41 276 6C276 132 289 239 307 279C282 327 275 360 273 404C334 402 369 393 402 372C420 379 445 401 457 422C445 442 420 464 402 471C369 449 334 441 273 439C276 506 281 532 311 583C297 609 275 635 252 647C231 635 207 609 194 583C223 532 229 506 232 439C171 442 135 450 103 471C84 463 60 441 49 422C60 401 84 379 103 372C135 393 171 402 232 404C230 360 224 327 199 279C217 239 228 132 228 6C229 -41 229 -72 227 -108H278Z" id="g50-15"></path></g><g transform="matrix(.013,0,0,-0.013,5.129,0)"><path d="M673 0V28C608 34 594 43 563 129C499 303 432 494 370 665L339 656L132 132C98 43 84 37 20 28V0H238V28C162 35 154 45 175 108C188 150 203 192 219 237H432C454 176 474 122 487 83S491 36 428 28V0H673ZM418 280H234C265 362 296 450 328 535H330L418 280Z" id="g121-63"></path></g><g transform="matrix(.013,0,0,-0.013,14.112,0)"><path d="M495 163C480 117 462 85 444 65C421 39 387 34 332 34C290 34 256 36 236 47C218 57 213 77 213 131V526C213 612 222 616 301 622V650H40V622C122 616 128 611 128 526V126C128 41 120 34 36 28V0H489C498 31 519 126 525 157L495 163Z" id="g121-74"></path></g><g transform="matrix(.013,0,0,-0.013,20.271,0)"><path d="M592 498C586 556 582 629 581 675H560C545 656 537 650 510 650H115C87 650 74 652 60 675H40C38 620 33 555 28 495H57C69 539 77 568 89 585C102 607 122 616 205 616H267V123C267 44 259 34 168 28V0H454V28C360 34 352 44 352 123V616H422C498 616 514 608 531 584C542 568 552 543 562 495L592 498Z" id="g121-82"></path></g></svg>:</span> Alanine Aminotransferase. <span class="nowrap"><svg height="15.608pt" id="M2" style="vertical-align:-3.833899pt" version="1.1" viewbox="-0.0498162 -11.7741 31.5298 15.608" width="31.5298pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M458 122C446 142 422 163 404 170C370 149 335 141 272 139V142C272 216 281 255 311 281C280 309 275 350 272 418C335 417 370 407 404 387C422 394 447 415 458 436C447 456 424 477 402 484C370 463 335 455 272 453C276 506 282 532 312 584C297 610 275 636 253 647C232 636 208 610 194 584C223 532 230 506 234 453C171 455 136 463 102 484C84 477 60 456 48 436C60 415 84 393 102 387C136 407 171 417 234 418C231 350 226 309 195 281C226 255 231 214 234 139C171 141 136 149 102 170C84 163 60 142 48 122C60 101 84 79 102 72C136 93 171 103 234 104C230 35 224 8 195 -42C208 -69 232 -94 254 -106C274 -94 298 -69 312 -42C282 8 276 35 272 104C335 103 370 93 404 72C422 79 446 101 458 122Z" id="g50-16"></path></g><g transform="matrix(.013,0,0,-0.013,5.111,0)"><path d="M716 650H478V622C549 617 570 605 575 566C579 535 582 493 582 401V326C582 161 537 40 393 40C269 40 205 133 205 294V521C205 611 213 617 291 622V650H33V622C111 615 120 611 120 521V272C120 154 148 80 208 34C252 0 309 -14 368 -14C434 -14 501 7 548 55C605 116 623 201 623 319V401C623 493 626 536 629 563C633 605 656 618 716 622V650Z" id="g121-83"></path></g><g transform="matrix(.013,0,0,-0.013,14.679,0)"><path d="M719 650H483V622C553 619 576 606 581 560C585 532 588 487 588 394V148H585L167 650H20V622C67 618 88 610 109 585C127 562 129 557 129 484V264C129 173 126 124 123 93C118 44 92 31 35 28V0H272V28C204 32 181 44 176 95C173 124 170 172 170 264V515H172L598 -9H629V394C629 487 631 532 635 563C639 606 663 619 719 622V650Z" id="g121-76"></path></g><g transform="matrix(.013,0,0,-0.013,24.338,0)"><path d="M495 163C480 117 462 85 444 65C421 39 387 34 332 34C290 34 256 36 236 47C218 57 213 77 213 131V526C213 612 222 616 301 622V650H40V622C122 616 128 611 128 526V126C128 41 120 34 36 28V0H489C498 31 519 126 525 157L495 163Z" id="g121-74"></path></g></svg>:</span> upper normal limit. ULN is 30 U/L for men and 19 U/L for females. <svg height="13.7903pt" id="M3" style="vertical-align:-3.83391pt" version="1.1" viewbox="-0.0498162 -9.95639 65.7031 13.7903" width="65.7031pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M558 106L533 129C501 84 476 67 464 67C446 67 435 116 414 239C457 297 508 367 550 440L539 451L484 438C458 390 429 338 404 300H402C375 407 351 451 285 451C168 451 24 312 24 153C24 56 66 -12 132 -12C206 -12 284 64 345 156H347C367 24 386 -12 422 -12C457 -12 503 7 558 106ZM338 206C272 99 215 56 173 56C140 56 116 96 116 170C116 303 194 405 255 405C304 405 324 299 338 206Z" id="g50-223"></path></g><g transform="matrix(.013,0,0,-0.013,5.814,0)"><path d="M409 504C401 567 396 607 392 642C354 654 312 665 266 665C137 665 60 583 60 487C60 374 161 325 225 290C300 250 355 215 355 141C355 68 311 21 235 21C131 21 86 122 71 183L41 176C48 128 61 42 68 21C78 16 93 8 118 0C142 -7 175 -15 216 -15C349 -15 438 69 438 174C438 287 344 333 265 374C186 414 138 449 138 522C138 576 172 631 249 631C336 631 363 562 380 499L409 504Z" id="g121-81"></path></g><g transform="matrix(.013,0,0,-0.013,11.898,0)"><path d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z" id="g121-103"></path></g><g transform="matrix(.013,0,0,-0.013,15.382,0)"><path d="M463 437C426 431 375 425 327 422C297 440 264 449 231 449H230C153 449 51 396 51 283C51 215 94 168 139 149C123 129 91 103 51 88C50 78 53 60 62 46C75 25 100 2 136 -9C112 -28 73 -59 53 -79C38 -94 29 -113 29 -135C30 -192 91 -257 203 -257C336 -257 452 -160 452 -59C452 39 371 59 309 59C275 59 240 58 203 58C158 58 140 77 140 96C140 110 157 129 170 138C186 135 205 133 221 133C306 133 396 185 396 293C396 328 384 360 366 381L423 378C439 387 459 413 468 429L463 437ZM219 418C277 418 314 362 314 284C314 205 275 166 231 165C176 165 137 221 137 299C137 376 177 418 219 418ZM241 -11C285 -11 314 -14 339 -24C367 -36 384 -61 384 -95C384 -157 335 -206 240 -206C166 -206 108 -165 108 -110C108 -82 128 -54 154 -32C172 -17 195 -11 241 -11Z" id="g121-101"></path></g><g transform="matrix(.013,0,0,-0.013,21.531,0)"><path d="M524 0V26C466 32 460 36 460 104V297C460 393 411 449 331 449C302 449 276 437 248 419C223 402 201 387 181 372V451C137 432 90 420 42 411V388C96 378 102 374 102 310V104C102 38 97 33 29 26V0H246V26C187 32 181 36 181 104V339C211 365 250 390 290 390C357 390 381 345 381 276V109C381 40 374 32 315 26V0H524Z" id="g121-108"></path></g><g transform="matrix(.013,0,0,-0.013,28.642,0)"><path d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z" id="g121-103"></path></g><g transform="matrix(.013,0,0,-0.013,32.126,0)"><path d="M517 0V26C453 32 447 37 447 100V450C395 439 339 437 259 437H180V471C180 551 194 602 213 628C225 647 246 664 275 664C322 664 356 632 379 605C387 596 396 596 408 604C417 609 425 619 430 628C434 639 434 651 425 664C414 680 379 710 319 712C281 708 235 690 194 658C140 614 120 563 112 538C106 517 101 491 101 460V437H53L25 408L29 397H101V100C101 38 93 33 30 26V0H250V26C187 32 180 38 180 100V397H316C365 397 368 390 368 345V100C368 37 361 31 305 26V0H517Z" id="g121-27"></path></g><g transform="matrix(.013,0,0,-0.013,39.081,0)"><path d="M390 111C344 68 312 56 269 56C212 56 118 102 118 241C118 346 175 401 241 401C277 401 312 388 342 360C350 352 355 349 361 349C372 349 394 371 394 392C394 403 391 411 378 422C362 436 329 449 288 449H287C250 449 190 432 138 392C71 341 37 274 37 197C37 90 112 -12 238 -12C297 -12 363 32 407 90L390 111Z" id="g121-97"></path></g><g transform="matrix(.013,0,0,-0.013,44.619,0)"><path d="M433 39L423 65C413 59 399 54 387 54C370 54 352 69 352 114V299C352 352 342 392 307 422C285 440 255 449 225 449C168 437 102 399 75 379C56 365 44 353 44 339C44 315 69 296 87 296C101 296 111 303 116 319C124 349 133 371 145 385C156 397 171 404 190 404C241 404 275 364 275 291V274C253 256 180 229 120 209C65 190 39 159 39 110C39 47 88 -12 159 -12C189 -12 237 25 277 52C282 35 288 21 301 8C312 -3 333 -12 348 -12L433 39ZM275 84C256 65 221 48 195 48C164 48 124 73 124 124C124 161 146 180 185 198C206 208 254 229 275 240V84Z" id="g121-95"></path></g><g transform="matrix(.013,0,0,-0.013,50.209,0)"><path d="M524 0V26C466 32 460 36 460 104V297C460 393 411 449 331 449C302 449 276 437 248 419C223 402 201 387 181 372V451C137 432 90 420 42 411V388C96 378 102 374 102 310V104C102 38 97 33 29 26V0H246V26C187 32 181 36 181 104V339C211 365 250 390 290 390C357 390 381 345 381 276V109C381 40 374 32 315 26V0H524Z" id="g121-108"></path></g><g transform="matrix(.013,0,0,-0.013,57.072,0)"><path d="M298 36L289 62C276 55 253 45 228 45C202 45 169 60 169 141V397H276C289 405 292 426 282 437H169V574L155 576L90 509V437H45L17 408L21 397H90V107C90 28 125 -12 188 -12C198 -12 213 -8 230 1L298 36Z" id="g121-114"></path></g></svg>fibrosis is defined by liver stiffness ≥ 8 kPa (by Fibroscan) or [AST]-to-platelet ratio index (APRI) ≥ 1.5. <svg height="13.8178pt" id="M4" style="vertical-align:-3.834pt" version="1.1" viewbox="-0.0498162 -9.9838 32.1887 13.8178" width="32.1887pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.0091,0,0,-0.0091,0,-5.741)"><path d="M347 450V435C378 435 393 427 393 411C393 407 390 397 385 381L292 117L176 376C170 390 167 401 167 409C167 424 186 433 224 435V450H19V435C46 431 63 420 72 401L103 334L248 25L203 -67C190 -92 184 -119 184 -148C184 -205 219 -234 288 -234C385 -238 425 -138 368 -34L316 74L426 373C426 374 434 393 435 398L441 410C449 423 462 433 480 435V450H347ZM309 -97C318 -117 323 -133 323 -144C323 -176 300 -201 268 -201C241 -201 227 -180 227 -137C227 -118 231 -99 238 -81L267 -13L309 -97Z"></path></g><g transform="matrix(.013,0,0,-0.013,5.065,0)"><path d="M495 163C480 117 462 85 444 65C421 39 387 34 332 34C290 34 256 36 236 47C218 57 213 77 213 131V526C213 612 222 616 301 622V650H40V622C122 616 128 611 128 526V126C128 41 120 34 36 28V0H489C498 31 519 126 525 157L495 163Z" id="g121-74"></path></g><g transform="matrix(.013,0,0,-0.013,12.138,0)"><path d="M135 536C164 536 186 560 186 587C186 617 164 639 136 639C109 639 85 617 85 587C85 560 109 536 135 536ZM252 0V26C188 32 181 38 181 106V451C138 433 90 420 39 412V388C99 379 102 374 102 312V106C102 38 95 32 32 26V0H252Z" id="g121-103"></path></g><g transform="matrix(.013,0,0,-0.013,15.53,0)"><path d="M478 437H300V411C357 404 363 393 347 345C325 280 293 190 258 107C229 178 188 284 163 354C147 397 149 405 203 411V437H-2V411C52 403 59 396 82 339C130 222 176 109 220 -11H248C304 138 356 261 390 336C417 395 425 404 478 411V437Z" id="g121-116"></path></g><g transform="matrix(.013,0,0,-0.013,21.64,0)"><path d="M380 106C343 72 306 56 265 56C195 56 116 112 115 248C235 252 361 262 377 265C396 269 400 277 400 297C400 374 333 449 250 449H249C198 449 144 421 103 376S37 269 37 201C37 88 109 -12 232 -12C263 -12 332 6 395 84L380 106ZM225 412C281 412 315 364 314 312C314 297 308 292 290 292C232 290 176 289 120 289C135 370 180 412 225 412Z" id="g121-99"></path></g><g transform="matrix(.013,0,0,-0.013,27.166,0)"><path d="M181 342V451C133 431 89 419 40 411V388C98 381 102 377 102 311V104C102 38 95 32 33 26V0H263V26C186 32 181 38 181 104V287C203 343 235 372 261 372C277 372 289 366 304 352C310 346 318 345 330 350C349 359 362 379 362 399C362 422 338 449 304 449C256 449 213 393 183 342H181Z" id="g121-112"></path></g></svg> cirrhosis is determined by liver stiffness ≥ 11 kPa (by Fibroscan) or APRI ≥ 2.0.</div>

Journal of Tropical Medicine

fig1

Figure 1

Figure 1: Hepatitis B Virus Infection in Tanzania: Current Status and Challenges 