Detection of HBeAg versus Viral DNA for the Management of People Infected with the Hepatitis B Virus in Burkina Faso, West Africa

HBeAg serves as a marker of wild-type viral replication of the hepatitis B virus (HBV). The detection of HBeAg is of significant clinical importance in the classification of chronic hepatitis B. Given the high frequency of mutations that can occur in the HBeAg gene, viral DNA detection is the most accurate marker of viral replication. In countries with limited resources, the cost of molecular tests represents a significant obstacle to their accessibility. Accordingly, the World Health Organization (WHO) recommends the use of HBeAg in conjunction with alanine aminotransferase (ALT) for the purpose of making therapeutic decisions. The objective of this study was twofold: firstly, to evaluate the suitability of HBeAg and HBV DNA for the clinical management of individuals infected with HBV in Bobo-Dioulasso, Burkina Faso; secondly, to ascertain the diagnostic performance of the Enzyme-Linked Fluorescent Assay (ELFA) for the detection of HBeAg. This cross-sectional study was conducted from March 1, 2023, to February 29, 2024, at the “Assaut-Hépatites” center in Bobo-Dioulasso. The study population consisted of patients who were HBsAg-positive and who presented to the laboratory for HBeAg testing and DNA quantification as part of an initial evaluation. HBeAg testing was conducted using the VIDAS HBe/Anti-HBe kit (Biomérieux, Marcy-l’Etoile, France), while HBV DNA quantification was performed by real-time PCR using the GENERIC HBV VIRAL LOAD version 2.0 (GHBV-CV) kit (BIOCENTRIC, Bandol, France). A total of 128 patients who tested negative for hepatitis B surface antigen (HBsAg) were included in the study. The mean age of the participants was 34.82 ± 11.02 years. The presence of HBeAg was identified in 5.5% (7/128) of participants. The presence of HBV DNA was confirmed in all participants, and 7.8% (10/128) exhibited a viral load (VL) exceeding 20,000 IU/mL. The sensitivity of the VIDAS HBe/anti-HBe test ranged from 18.51% for a viral DNA detection threshold of >2000 IU/mL to 75.00% for a threshold of >2,000,000 IU/mL. Notwithstanding the low diagnostic sensitivity of the test, the results demonstrated that there was no statistically significant difference between the proportions of individuals eligible for treatment on the basis of HBeAg (5.5%) and VL (7.8%).