A groundbreaking study reveals the hidden landscape of a viral infection affecting thousands in Eritrea.
Published: June 2024 | Medical Research
In the bustling hospitals of Asmara, a quiet public health story unfolds—one that reflects both global challenges and local realities. Hepatitis B virus (HBV) infection represents a significant global health concern, with approximately 296 million people living with chronic infection worldwide 2 . In Eritrea, studies reveal a seroprevalence rate of 2.3%, meaning thousands of citizens are navigating the complexities of this viral infection 4 .
Many infected individuals experience no noticeable symptoms for years, all while the virus may be causing progressive liver damage 8 .
To appreciate the Eritrean research findings, it helps to understand what doctors look for when diagnosing and monitoring hepatitis B. The virus presents itself through specific serological markers—detectable antibodies and antigens that tell the story of the infection's stage and activity.
The triple panel test has emerged as the gold standard for screening, consisting of three key markers 8 :
High viral load with minimal liver inflammation
High viral load with elevated liver enzymes
Low viral replication with normal liver enzymes
In 2021, a pioneering study offered the first comprehensive look at hepatitis B in Eritrea. Published in BMC Gastroenterology, this research analyzed 293 chronic HBV patients from treatment centers in Asmara to determine the distribution across different infection phases 7 .
High viral load, minimal liver inflammation
High viral load, elevated liver enzymes
Low viral replication, normal liver enzymes
This distribution proved notably favorable compared to global patterns. The remarkably low percentage of immune-tolerant patients—typically associated with perinatal infection—suggests the success of Eritrea's childhood immunization program, which incorporated HBV vaccination in 2002 7 .
A subsequent 2025 study published in Scientific Reports expanded our understanding of hepatitis B management in Eritrea, following 413 patients across three treatment centers in Asmara 4 . This research revealed both encouraging trends and systemic challenges in the country's approach to hepatitis B.
The findings highlighted issues of late presentation and significant loss to follow-up (LTFU), with 23.9% of patients failing to continue their medical monitoring 4 . These gaps in care represent serious concerns, as regular monitoring is essential for detecting when inactive infections become active and require treatment.
The research also provided valuable insights into treatment efficacy, comparing tenofovir disoproxil fumarate (TDF) monotherapy versus TDF plus lamivudine (LAM) combination therapy 4 . After 12 weeks of treatment, the overall virological response rate was 60.7%, with no statistically significant difference between the two regimens 4 . This real-world evidence helps inform treatment protocols in resource-limited settings.
Conducting meaningful hepatitis B research requires specific laboratory tools and methodologies. The Eritrean studies employed a range of techniques to build a comprehensive picture of the virus's behavior in the local population.
| Research Tool | Function | Application in Eritrea Studies |
|---|---|---|
| Serological Testing | Detects antibodies and antigens | Classifying infection phases using HBsAg, HBeAg, anti-HBc 7 |
| HBV DNA Quantification | Measures viral load | COBAS® system used to determine replication levels 4 |
| Liver Function Tests | Assesses liver inflammation | ALT/AST measurements to evaluate liver damage 4 7 |
| FIB-4 Index | Estimates liver fibrosis | Non-invasive alternative to liver biopsy 4 |
| Complete Blood Count | Evaluates overall health status | Platelet count particularly important for fibrosis assessment 4 |
These tools allowed researchers to move beyond simple diagnosis to understanding the complex interplay between virus and host—a crucial step for determining which patients need immediate treatment versus those who can be safely monitored.
The Eritrean hepatitis B research provides more than just academic insights—it offers a roadmap for public health action. The predominance of inactive infection phases suggests that the country's vaccination program is bearing fruit, potentially reducing future complications 7 . However, the high rates of loss to follow-up highlight systemic challenges that need addressing 4 .
As the World Health Organization works toward its goal of reducing hepatitis-related mortality by 65% by 2030, studies like those conducted in Eritrea will be increasingly important 4 .
The serological and virological profiling of hepatitis B patients in Eritrea reveals a landscape of both promise and challenge. The high proportion of inactive carriers suggests successful prevention efforts, particularly through childhood vaccination. Yet the significant rates of late presentation and loss to follow-up underscore the work still needed.
What emerges is a compelling picture of a healthcare system grappling with complex viral infection—making strides in some areas while facing persistent challenges in others. As research continues to inform practice, there is genuine hope that Eritrea can build on its successes to address remaining gaps, offering better outcomes for thousands living with hepatitis B.
The silent battle against this viral infection continues, but through scientific inquiry and public health commitment, it is a battle increasingly fought on terms favorable to patients and providers alike.
This article is based on published scientific research from Eritrean treatment centers and international hepatitis B literature.