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Lee HW, Kim SU, Baatarkhuu O, Park JY, Kim DY, Ahn SH, Han KH, Kim BK. Comparison between chronic hepatitis B patients with untreated immune-tolerant phase vs. those with virological response by antivirals. Sci Rep 2019; 9:2508. [PMID: 30792468 PMCID: PMC6385334 DOI: 10.1038/s41598-019-39043-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/14/2019] [Indexed: 12/18/2022] Open
Abstract
Routine nucleos(t)ide analogs (NUCs) have not yet been recommended for patients with immune-tolerant (IT) phase in chronic hepatitis B virus (HBV) infection. We aimed to evaluate prognosis of patients in untreated IT-phase (UIT group), compared to those in immune-active phase who achieved virological response by NUCs according to guidelines (VR group). Between 2006 and 2012, patients in UIT or VR groups were included. Cumulative risks of HCC and liver-related events (LREs) development were assessed. Furthermore, propensity-score was calculated based upon age, gender, diabetes and liver stiffness. UIT group (n = 126) showed younger age, lower proportion of male gender and lower LS than VR group (n = 641). UIT group had similar 10-year cumulative risks of HCC (2.7% vs. 2.9%, p = 0.704) and LRE (4.6% vs. 6.1%, p = 0.903) development, compared to VR group. When we re-defined UIT group by the lower ALT cut-offs, 10-year cumulative risks of HCC and LRE development were 2.9% and 4.8%, respectively. Using propensity-score matching and inverse probability treatment weighting analysis, similar results were reproduced. UIT group consistently had similar prognosis compared to VR group. Therefore, further large-scale prospective studies in order to verify rationales of routine NUCs in UIT group are still required.
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Affiliation(s)
- Hye Won Lee
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Oidov Baatarkhuu
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Jun Yong Park
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Kwang-Hyub Han
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal medicine, Yonsei University College of medicine, Seoul, Republic of Korea.
- Institute of Gastroenterology, Yonsei University College of medicine, Seoul, Republic of Korea.
- Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
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52
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Gourari S, Brichler S, Le Gal F, Abdou-Chekaraou M, Beloufa MA, Khelifa R, Djaballah H, Boufekane M, Nani A, Afredj N, Debzi N, Dény P, Gordien E, Tazir M. Hepatitis B virus and hepatitis delta virus subtypes circulating in Algeria and seroprevalence of HDV infection. J Med Virol 2018; 91:72-80. [PMID: 30168584 DOI: 10.1002/jmv.25301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 06/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known about molecular characteristics of HBV strains circulating in Algeria and there are few data regarding HDV infection. OBJECTIVES The aim of this study is to describe the genetic diversity of HBV and HDV strains existing in Algeria and to determine the seroprevalence of HDV infection. STUDY DESIGN Plasma samples from 134 patients were analyzed by enzyme immunoassay method for HBV and HDV serological markers. Genotyping of HBV and HDV strains were performed using direct sequencing followed by phylogenetic analyses of the PreS1 and R0 region of the HBV and HDV genome respectively. RESULTS The PreS1 gene was successfully amplified in 119 patients (82 males and 37 females). Phylogenetic analysis of HBV strains revealed the presence of genotypes D (86.5%) and A2 (11.76%). The subgenotypes D are distributed as follows: HBV/D7 (43.5%), HBV/D3 (24.75%), HBV/D1 (16.8%) and HBV/D2 (14.85%). A recombinant between genotypes A, E and D was found. The seroprevalence of HDV infection among HBV carriers was less than 5.35%. Only one isolate of HDV genotype 1 was identified. CONCLUSIONS Our data indicate the predominance of HBV subgenotype D7 and a low prevalence of HDV infection.
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Affiliation(s)
- Samir Gourari
- Service de Microbiologie, CHU Mustapha, Algiers, Algeria
| | - Ségolène Brichler
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Frédéric Le Gal
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Mariama Abdou-Chekaraou
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | | | - Rim Khelifa
- Service de Microbiologie, CHU Mustapha, Algiers, Algeria
| | | | | | | | - Nawel Afredj
- Service d'Hépatologie, CHU Mustapha, Algiers, Algeria
| | - Nabil Debzi
- Service d'Hépatologie, CHU Mustapha, Algiers, Algeria
| | - Paul Dény
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Emmanuel Gordien
- Service de Bactériologie, Virologie-Hygiène, Laboratoire associé au Centre National de Référence des Hépatites B, C et delta, Hôpital Avicenne, Bobigny, France
| | - Mohamed Tazir
- Service de Microbiologie, CHU Mustapha, Algiers, Algeria
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53
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Ren P, Cao Z, Mo R, Liu Y, Chen L, Li Z, Zhou T, Lu J, Liu Y, Guo Q, Chen R, Zhou H, Xiang X, Cai W, Wang H, Bao S, Xu Y, Gui H, Xie Q. Interferon-based treatment is superior to nucleos(t)ide analog in reducing HBV-related hepatocellular carcinoma for chronic hepatitis B patients at high risk. Expert Opin Biol Ther 2018; 18:1085-1094. [PMID: 30182763 DOI: 10.1080/14712598.2018.1518423] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effect of nucleos(t)ide analogs (NAs) versus interferon (IFN) on the occurrence of hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) is controversial. We assessed whether antiviral strategy affected HCC development in CHB patients at different HCC risks. METHODS 1112 CHB patients with antiviral therapy were included in this retrospective study. Patients treated with NAs only were classified into NAs group (n = 682) while those received IFN treatment with or without NAs were defined as IFN group (n = 430). Propensity score matching (PSM) was applied to minimize baseline differences. RESULTS Totally, 31 patients developed HCC during follow-up (median 5.41 years). The cumulative HCC incidence at 10 years was significantly lower in the IFN group than NAs group (2.7% vs 8.0%, p < 0.001). Similar results were obtained in the PSM-cohort. Patients with IFN-based treatment were less likely to develop HCC than those with NAs (Hazard ratio = 0.15; 95% CI 0.04-0.66; p = 0.012). Subgroup analyses demonstrated that this superiority of IFN in reducing HCC development was obvious in patients at high- but not low-risk of HCC. CONCLUSIONS Reduction of HCC development was more significant in CHB patients at higher HCC risk with IFN-based therapy than NAs treatment.
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Affiliation(s)
- Peipei Ren
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Zhujun Cao
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ruidong Mo
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yuhan Liu
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Lichang Chen
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Ziqiang Li
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Tianhui Zhou
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Jie Lu
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Yunye Liu
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Qing Guo
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Rong Chen
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Huijuan Zhou
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Xiaogang Xiang
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Wei Cai
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Hui Wang
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Shisan Bao
- b Discipline of Pathology , the University of Sydney , Sydney , NSW , Australia
| | - Yumin Xu
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Honglian Gui
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
| | - Qing Xie
- a Department of Infectious Diseases , Ruijin Hospital, Shanghai Jiao Tong University School of Medicine , Shanghai , China
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54
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Han E, Lee YH, Kim BK, Park JY, Kim DY, Ahn SH, Lee BW, Kang ES, Cha BS, Han KH, Kim SU. Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B. Aliment Pharmacol Ther 2018; 48:300-312. [PMID: 29920701 DOI: 10.1111/apt.14843] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/02/2017] [Accepted: 05/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Sarcopenia is significantly associated with the degree of liver fibrosis. This study investigated the influence of sarcopenia on liver fibrosis in individuals with chronic hepatitis B. METHODS Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analysed. The sarcopenia index (total appendicular skeletal muscle mass [kg]/body mass index [kg/m2 ]) was calculated using dual-energy X-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cut-offs: 0.89 for men and 0.58 for women). The fibrotic burden was assessed using the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index. Significant fibrosis was defined as the highest nonalcoholic fatty liver disease fibrosis score quartile and a fibrosis-4 index ≥2.67. RESULTS Among the 506 respondents with chronic hepatitis B (258 men and 248 women), the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index identified sarcopenia and significant fibrosis in 126 (24.9%) and 217 (42.9%), respectively. Sarcopenia was significantly associated with significant fibrosis, regardless of the fibrosis prediction model used (all P < 0.05). When the study population was stratified according to metabolic factors, sarcopenia was specifically associated with an increased risk of significant fibrosis among subgroups with obesity, insulin resistance, metabolic syndrome and liver steatosis (odds ratio 2.37-3.57; all P < 0.05). An independent association between sarcopenia and significant fibrosis was identified after adjusting for other confounders (odds ratio 2.67-3.62 by the nonalcoholic fatty liver disease fibrosis score and 2.04-2.62 by the fibrosis-4 index; all P < 0.05). CONCLUSIONS Sarcopenia is associated with significant fibrosis in subjects with chronic hepatitis B, specifically those with obesity, insulin resistance, metabolic syndrome and liver steatosis.
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Affiliation(s)
- E Han
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Y-H Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - B K Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - J Y Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - D Y Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - S H Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - B-W Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - E S Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - B-S Cha
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - K-H Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - S U Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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55
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Sousa DDD, Silva CRDS, Lima Junior WP, Barros JDA, Nascimento IADS, Souza VCD, Naveca FG, Granja F. Phylogenetic analysis and genotype distribution of Hepatitis B Virus (HBV) in Roraima, Brazil. Rev Inst Med Trop Sao Paulo 2018; 60:e35. [PMID: 30043939 PMCID: PMC6056886 DOI: 10.1590/s1678-9946201860035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
Hepatitis B virus (HBV) infection is a serious global health problem. HBV has a
high viral genetic diversity, with 10 genotypes recognized. In Brazil, the
Roraima State is the third in the Northern region regarding the number of
hepatitis B cases. On the other hand, few data on HBV genotyping and
phylogenetic analysis are available. The purpose of this study is to
characterize the HBV genotypes circulating in Roraima State. Of the 113 chronic
hepatitis B patients enrolled in this study, 40 were HBV-DNA positive. A
fragment of 280 bp (S gene) was amplified by PCR and submitted to nucleotide
sequencing. A dataset containing the viral sequences obtained in this study,
plus 130 obtained from GenBank was used for genotyping by phylogenetic analysis.
The HBV subgenotype distribution found was A1 (62.5%), A2 (7.5%), D2, D3, D4
(2.5%), F2a (12.5%), and F3 (10%). We characterized the genotypes and
subgenotypes of HBV circulating among patients in the State of Roraima. In
addition, our study shows for the first time the HBV/F3 genotype circulating in
Brazil. In conclusion, our findings showed a high diversity of HBV genotypes in
Roraima, which is also found in other Brazilian geographical regions.
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Affiliation(s)
- Débora Dinelly de Sousa
- Universidade Federal de Roraima, Centro de Estudos da Biodiversidade, Laboratório de Biologia Molecular, Boa Vista, Roraima, Brazil
| | - Claudiane Raquel de Sousa Silva
- Universidade Federal de Roraima, Centro de Estudos da Biodiversidade, Laboratório de Biologia Molecular, Boa Vista, Roraima, Brazil
| | - Wilson Pereira Lima Junior
- Universidade Federal de Roraima, Centro de Estudos da Biodiversidade, Laboratório de Biologia Molecular, Boa Vista, Roraima, Brazil
| | - Jacqueline de Aguiar Barros
- Departamento de Vigilância Epidemiológica, Coordenação Geral de Vigilância em Saúde, SESAU/RR, Boa Vista, Roraima, Brazil
| | | | | | - Felipe Gomes Naveca
- Fiocruz-Amazônia, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil
| | - Fabiana Granja
- Universidade Federal de Roraima, Centro de Estudos da Biodiversidade, Laboratório de Biologia Molecular, Boa Vista, Roraima, Brazil
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56
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Bannister EG, Yuen L, Littlejohn M, Edwards R, Sozzi V, Colledge D, Li X, Locarnini S, Hardikar W, Revill PA. Molecular characterization of hepatitis B virus (HBV) in African children living in Australia identifies genotypes and variants associated with poor clinical outcome. J Gen Virol 2018; 99:1103-1114. [PMID: 29932395 DOI: 10.1099/jgv.0.001086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Migration from sub-Saharan Africa is contributing to the rising incidence of chronic hepatitis B (CHB) infection and its complications in Australia. African CHB is associated with unique genotypes, such as E and A1, which are associated with reduced vaccine efficacy and early-onset hepatocellular carcinoma, respectively, although the prevalence of these genotypes outside Africa is poorly described. Treatment-naïve children of African origin with CHB were recruited at the Royal Children's Hospital Melbourne. Population-based sequencing of the complete HBV genome, or the clinically relevant basal core promoter (BCP)/precore (PC) region, was performed, and the HBV genotype/subgenotype assigned by phylogenetic analysis. HBV was characterized in serum from 67 children, median age 12.5 years. HBV genotype E was most frequent (70 %), with genotype D [25 %; subgenotypes D6 (formerly D7)/D3/D2)] and subgenotype A1 (5 %) also being identified. Despite their young age, over 50 % of the children were HBeAg-negative and had seroconverted to anti-HBe, with this being associated with canonical BCP/PC mutations in the majority of cases. The profile of HBV in African children living in Australia was characterized by early HBeAg seroconversion and infection with HBV variants associated with poor clinical outcome, as well as genotypes previously associated with reduced vaccine efficacy or rapid progression to liver cancer. These findings have important ramifications for patient monitoring and treatment guidelines in the Australian paediatric setting.
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Affiliation(s)
- Elizabeth G Bannister
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia.,2Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.,3Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Lilly Yuen
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Margaret Littlejohn
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Rosalind Edwards
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Vitina Sozzi
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Danni Colledge
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Xin Li
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Stephen Locarnini
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia
| | - Winita Hardikar
- 2Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria, Australia.,3Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Peter A Revill
- 1Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute of Infection and Immunity, Melbourne, 3000 Victoria, Australia.,4Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
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57
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Sozzi V, Shen F, Chen J, Colledge D, Jackson K, Locarnini S, Yuan Z, Revill PA. In vitro studies identify a low replication phenotype for hepatitis B virus genotype H generally associated with occult HBV and less severe liver disease. Virology 2018; 519:190-196. [PMID: 29734042 DOI: 10.1016/j.virol.2018.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/27/2018] [Accepted: 04/19/2018] [Indexed: 01/05/2023]
Abstract
Hepatitis B virus (HBV) exists as 9 major genotypes and multiple subtypes, many of which exhibit differences in pathogenicity and treatment response. Genotype H identified in Central America is associated with low incidence of liver disease and HCC, but higher incidence of occult HBV (low level HBV DNA positivity, HBsAg negative). The replication phenotype of genotype H associated with less severe forms of liver disease is unknown. We hypothesized that the reduced pathogenesis associated with this genotype may be due to by lower rates of viral replication and/or secretion compared to other characterised strains. We used transient transfection and infection cell culture models to characterise the replication phenotype, compared to our D3 reference strain. Genotype H exhibited reduced viral replication and altered envelope protein expression compared to genotype D, with functional studies showing that low replication was in part likely due to sequence differences in the major transcriptional regulatory region.
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Affiliation(s)
- Vitina Sozzi
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute of Infection and Immunity, 792 Elizabeth St, Melbourne, 3000 Victoria, Australia
| | - Fang Shen
- Key Laboratory of Medical Molecular Virology, School of Basic and Medical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Jieliang Chen
- Key Laboratory of Medical Molecular Virology, School of Basic and Medical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Danni Colledge
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute of Infection and Immunity, 792 Elizabeth St, Melbourne, 3000 Victoria, Australia
| | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute of Infection and Immunity, 792 Elizabeth St, Melbourne, 3000 Victoria, Australia
| | - Stephen Locarnini
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute of Infection and Immunity, 792 Elizabeth St, Melbourne, 3000 Victoria, Australia
| | - Zhenghong Yuan
- Key Laboratory of Medical Molecular Virology, School of Basic and Medical Sciences, Shanghai Medical College of Fudan University, Shanghai, China
| | - Peter A Revill
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute of Infection and Immunity, 792 Elizabeth St, Melbourne, 3000 Victoria, Australia.
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58
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Sharma B, Katiyar H, Barall D, Sharma N, Agnihotry S, Goel A, Aggarwal R. Genotyping of hepatitis B virus isolates from Lahaul and Spiti district in Himachal Pradesh, India. Indian J Gastroenterol 2018; 37:261-265. [PMID: 29855856 DOI: 10.1007/s12664-018-0854-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/13/2018] [Indexed: 02/04/2023]
Abstract
Hepatitis B virus (HBV) has several genotypes. In the Indian population, genotypes A and D are the most frequent. HBV infection is hyper-endemic in the Lahaul and Spiti district in Himachal Pradesh; however, the virus genotype in this area is not known. We sequenced a 398-nucleotide segment of HBV genome that included parts of pre-S1/S2 and polymerase genes from 17 specimens from this district, and assigned a viral genotype to these. Of the 17 specimens studied, 13 (76% [95% confidence interval = 50-92%]) showed the presence of genotype C HBV; the remaining four were genotype D (n = 4; 24%) HBV. Prevalence of genotype C HBV was much higher in the district than in other parts of India. This may reflect the historical mixing of this population with that in China. Since genotype C has a higher risk of chronicity and mother-to-child transmission, prevention of HBV infection may need particular emphasis in this area.
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Affiliation(s)
- Brij Sharma
- Department of Gastroenterology, Indira Gandhi Medical College, Ridge Sanjauli Road, Lakkar Bazar, Shimla, 171 001, India
| | - Harshita Katiyar
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Deepesh Barall
- National Health Mission, Vikas Nagar - SDA Complex Road, SDA Complex, Kasumpti, Shimla, 171 009, India
| | - Neetu Sharma
- Department of Physiology, Indira Gandhi Medical College, Ridge Sanjauli Road, Lakkar Bazar, Shimla, 171 001, India
| | - Shikha Agnihotry
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Amit Goel
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
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59
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Xiang-Chun D, Xiao-Qing Y, Ting-Ting Y, Zhen-Hui L, Xiao-Yan L, Xia L, Yan-Chao H, Yi-Xuan Y, Li-Na M. Alpha-enolase regulates hepatitis B virus replication through suppression of the interferon signalling pathway. J Viral Hepat 2018; 25:289-295. [PMID: 29080231 DOI: 10.1111/jvh.12813] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/21/2017] [Indexed: 12/18/2022]
Abstract
Persistent chronic infection with hepatitis B virus (HBV) is a major risk factor for the development of HBV-related diseases. The molecular mechanisms that underlie HBV infection and associated carcinogenesis are not fully understood. The aim of this study was to explore the role of ENO1 in HBV replication processes. Here, we examined ENO1 expression levels in HBV-infected and non-HBV-infected liver tissues and cells by Western blot analysis, real-time PCR and immunohistochemistry. In addition, HBsAg and HBeAg in the media of transfected HepG2.2.15 cells were detected using an electrochemical luminescence analyser within 48 hours after ENO1-specific siRNA transfection. The expression levels of HBV DNA, type I interferon and 5 downstream IFN-stimulated genes in HepG2.2.15 cells were examined using real-time PCR. We found ENO1 expression was upregulated in the HBV-infected liver tissues and cells. Silencing of ENO1 resulted in a significant reduction in HBV replication, and this siRNA-mediated reaction also caused the upregulation of expression of type I interferon and downstream IFN-stimulated genes. Therefore, we come to the conclusion ENO1 is involved in HBV replication. It is therefore likely that HBV replication is enhanced following suppression of the IFN signalling pathway. However, the mechanisms that underpin ENO1-mediated modulation of the IFN signalling pathway remain to be elucidated.
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Affiliation(s)
- D Xiang-Chun
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Y Xiao-Qing
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Y Ting-Ting
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - L Zhen-Hui
- Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - L Xiao-Yan
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - L Xia
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - H Yan-Chao
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Y Yi-Xuan
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - M Li-Na
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Kim BS, Seo YS, Kim YS, Lee CH, Lee HA, Um SH, Yoo JJ, Kim SG, Suh SJ, Jung YK, Ahn SH, Han KH, Yim HJ, Kim SU. Reduced risk of hepatocellular carcinoma by achieving a subcirrhotic liver stiffness through antiviral agents in hepatitis B virus-related advanced fibrosis or cirrhosis. J Gastroenterol Hepatol 2018; 33:503-510. [PMID: 28666070 DOI: 10.1111/jgh.13854] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM A subcirrhotic range of liver stiffness (sc-LS), assessed by transient elastography, is associated with better outcomes in patients with chronic hepatitis B (CHB). We investigated whether the achievement of sc-LS by antiviral therapy (AVT) reduced the risk of developing hepatocellular carcinoma (HCC) in patients with CHB-related advanced fibrosis or cirrhosis. METHODS In total, 209 patients with CHB-related advanced fibrosis or cirrhosis, who received paired transient elastography examinations during AVT between 2007 and 2012, were enrolled. The cut-off LS value for ultrasonographic cirrhosis was defined as 11.6 kPa. RESULTS The median age of the study population was 51 years, with males predominating (n = 138, 66.0%). The median LS value at enrollment was 14.1 kPa (interquartile range: 9.5-24.1 kPa). After 2 years of AVT, 140 (67.0%) patients achieved sc-LS. During the study period, 28 (13.4%) patients developed HCC after 2 years of AVT. On multivariate analysis, the achievement of sc-LS after AVT was independently associated with a decreased risk of HCC development (hazard ratio [HR] = 0.485, P = 0.047), whereas older age (HR = 1.071) and male gender (HR = 3.704) were independently associated with an increased HCC risk (both P < 0.05). Patients with a cirrhotic range of LS value after 2 years of AVT were at a higher risk of HCC development than those with sc-LS (log-rank test, P = 0.020). CONCLUSIONS The achievement of sc-LS after AVT can reduce the risk of HCC development in patients with CHB, even when advanced fibrosis or cirrhosis is apparent on starting AVT.
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Affiliation(s)
- Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Chang Hyeong Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Han Ah Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Ho Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jeong-Ju Yoo
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sang Gyune Kim
- Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sang Jun Suh
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young Kul Jung
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Block TM, Alter H, Brown N, Brownstein A, Brosgart C, Chang KM, Chen PJ, Cohen C, El-Serag H, Feld J, Gish R, Glenn J, Greten TF, Guo JT, Hoshida Y, Kowdley KV, Li W, Lok AS, McMahon B, Mehta A, Perrillo R, Rice CM, Rinaudo J, Schinazi RF, Shetty K. Research priorities for the discovery of a cure for chronic hepatitis B: Report of a workshop. Antiviral Res 2017; 150:93-100. [PMID: 29248746 PMCID: PMC6309822 DOI: 10.1016/j.antiviral.2017.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/08/2017] [Indexed: 02/09/2023]
Abstract
In early 2017, the Hepatitis B Foundation invited 30 experts in the fields of hepatitis B and liver cancer research to identify projects they deemed important to the goal of finding a cure for chronic hepatitis B and D and the diseases with which these viral infections are associated. They were also asked to identify general categories of research and to prioritize sub-project topics within those areas. The experts generally agreed on broadly defined areas of research, but there was usually little difference between the highest and lowest scoring projects; for the most part, all programs described in this document were considered valuable and necessary. An executive summary of this discussion was recently published (Alter et al., Hepatology 2017). The present manuscript reports the areas of research identified by the workshop participants, provides a brief rationale for their selection, and attempts to express differences among the priorities assigned to each area of research, when such distinctions were expressed.
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Affiliation(s)
- Timothy M Block
- Hepatitis B Foundation, Doylestown, PA, USA; Baruch S Blumberg Institute, Doylestown, PA, USA.
| | - Harvey Alter
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Nathaniel Brown
- Hepatitis B Foundation, Doylestown, PA, USA; Baruch S Blumberg Institute, Doylestown, PA, USA
| | | | - Carol Brosgart
- U. California San Francisco School of Medicine and U. California at Berkeley School of Public Health, National Viral Hepatitis Roundtable, USA
| | - Kyong-Mi Chang
- University of Pennsylvania School of Medicine and the Philadelphia Veterans Hospital, Philadelphia, PA, USA
| | | | - Chari Cohen
- Hepatitis B Foundation, Doylestown, PA, USA; Baruch S Blumberg Institute, Doylestown, PA, USA
| | | | | | - Robert Gish
- Hepatitis B Foundation, Doylestown, PA, USA; Stanford University Medical Center and Hospital, Palo Alto, CA, USA
| | - Jeffrey Glenn
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tim F Greten
- National Cancer Institute, NIH, Bethesda, MD, USA
| | | | | | | | - Wenhui Li
- National Institute of Biological Sciences, Beijing, China
| | - Anna S Lok
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Anand Mehta
- Medical University of South Carolina, Charleston, SC, USA
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62
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Bayliss J, Yuen L, Rosenberg G, Wong D, Littlejohn M, Jackson K, Gaggar A, Kitrinos KM, Subramanian GM, Marcellin P, Buti M, Janssen HLA, Gane E, Sozzi V, Colledge D, Hammond R, Edwards R, Locarnini S, Thompson A, Revill PA. Deep sequencing shows that HBV basal core promoter and precore variants reduce the likelihood of HBsAg loss following tenofovir disoproxil fumarate therapy in HBeAg-positive chronic hepatitis B. Gut 2017; 66:2013-2023. [PMID: 27534671 DOI: 10.1136/gutjnl-2015-309300] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Hepatitis B e antigen (HBeAg) seroconversion and hepatitis B surface antigen (HBsAg) loss are important clinical outcomes for patients with chronic hepatitis B (CHB) treated with antiviral therapy. To date, there have been few studies that have evaluated viral sequence markers predicting serological response to nucleos(t)ide analogue (NA) treatment. DESIGN We used next-generation sequencing (NGS) and quantitative HBV serology (HBeAg and HBsAg) to identify viral sequence markers associated with serological response to long-term tenofovir disoproxil fumarate therapy among HBeAg-positive patients. In the GS-US-174-0103 study, approximately half the patients seroconverted to anti-HBe by week 192 and 11% of patients exhibited HBsAg loss, the closest outcome to functional cure. The frequency of HBV variants that have previously been associated with HBV clinical outcomes was evaluated. HBV viral diversity in baseline sequences generated by NGS was calculated using Shannon entropy. RESULTS NGS analysis of HBV sequences from 157 patients infected with genotypes A to D showed the frequency of variants in the basal core promoter (BCP) and precore (PC) regions varied by genotype and that these mutations were associated with the absence of HBsAg loss. This was the case even when mutations were present at frequencies below the threshold of detection by population sequencing. Increased viral diversity across the HBV genome as determined by NGS was also associated with reduced likelihood of HBsAg loss. CONCLUSION Patients with detectable BCP and/or PC variants and higher viral diversity have a lower probability of HBsAg loss during long-term NA therapy. Strategies to achieve functional cure of HBV infection through combination therapy should consider using NGS to stratify patients according to BCP/PC sequence. Consideration should also be given to earlier initiation of therapy prior to the emergence of BCP/PC variants. TRIAL REGISTRATION NUMBER NCT00116805; Post result.
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Affiliation(s)
- Julianne Bayliss
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Lilly Yuen
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Gillian Rosenberg
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Darren Wong
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Margaret Littlejohn
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kathleen Jackson
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Anuj Gaggar
- Gilead Sciences, Foster City, California, USA
| | | | | | | | - Maria Buti
- Liver Unit, Valle d'Hebron (Ciberehd) University Hospital, Barcelona, Spain
| | - Harry L A Janssen
- Toronto Center for Liver Diseases, Toronto Western and General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ed Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Vitina Sozzi
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Danni Colledge
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Rachel Hammond
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Rosalind Edwards
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Stephen Locarnini
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Alexander Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter A Revill
- Division of Molecular Research and Development, Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Liu B, Yang JX, Yan L, Zhuang H, Li T. Novel HBV recombinants between genotypes B and C in 3'-terminal reverse transcriptase (RT) sequences are associated with enhanced viral DNA load, higher RT point mutation rates and place of birth among Chinese patients. INFECTION GENETICS AND EVOLUTION 2017; 57:26-35. [PMID: 29111272 DOI: 10.1016/j.meegid.2017.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022]
Abstract
As one of the major global public health concerns, hepatitis B virus (HBV) can be divided into at least eight genotypes, which may be related to disease severity and treatment response. We previously demonstrated that genotypes B and C HBV, with distinct geographical distribution in China, had divergent genotype-dependent amino acid polymorphisms and variations in reverse transcriptase (RT) gene region, a target of antiviral therapy using nucleos(t)ide analogues. Recently recombination between HBV genotypes B and C was reported to occur in the RT region. However, their frequency and clinical significance is poorly understood. Here full-length HBV RT sequences from 201 Chinese chronic hepatitis B (CHB) patients were amplified and sequenced, among which 31.34% (63/201) were genotype B whereas 68.66% (138/201) genotype C. Although no intergenotypic recombination was detected among C-genotype HBV, 38.10% (24/63) of B-genotype HBV had recombination with genotype C in the 3'-terminal RT sequences. The patients with B/C intergenotypic recombinants had significantly (P<0.05) higher serum HBV DNA level than the "pure" B-genotype cohort did. Moreover, the B/C intergenotypic recombinants were prone to more substitutions at several specific residues in the RT region than genotype B or C. Besides, unlike their parental genotypes, the recombinant HBV appeared to display an altered geographic distribution feature in China. Our findings provide novel insight into the virological, clinical and epidemiological features of new HBV B/C intergenotypic recombinants at the 3' end of RT sequences among Chinese CHB patients. The highly complex genetic background of the novel recombinant HBV carrying new mutations affecting RT protein may contribute to an enhanced heterogeneity in treatment response or prognosis among CHB patients.
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Affiliation(s)
- Baoming Liu
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China; Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Jing-Xian Yang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Ling Yan
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Hui Zhuang
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Tong Li
- Department of Microbiology and Center of Infectious Diseases, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China.
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Jaquet A, Nouaman M, Tine J, Tanon A, Anoma C, Inwoley A, Attia A, Ekouevi DK, Seydi M, Dabis F, Wandeler G. Hepatitis B treatment eligibility in West Africa: Uncertainties and need for prospective cohort studies. Liver Int 2017; 37:1116-1121. [PMID: 28561454 PMCID: PMC5524454 DOI: 10.1111/liv.13484] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS While universal screening of hepatitis B virus (HBV) is recommended in high burden countries, little is known about the proportion of HBV-infected persons in need of antiviral therapy in these settings. METHODS Prisoners in Senegal and Togo as well as female sex workers and men who have sex with men in Cote d'Ivoire were screened for HBV infection. All HBsAg-positive participants underwent transient elastography, alanine aminotransferase (ALT) and HBV viral load (VL) quantification. Individuals with cirrhosis or those aged >30 years with an HBV replication ≥20 000 IU/mL and elevated ALT were considered eligible for antiviral therapy. RESULTS Of 1256 participants, 110 (8.8%) were HBsAg positive; their median age was 30 years [interquartile range: 25-33] and 96 (86.5%) were men. Three individuals (2.7%) had cirrhosis, while 28 (29.5%) of 94 participants with available measurements had an HBV VL ≥20 000 IU/mL. Overall, 11 (10.0%) subjects were considered eligible for immediate antiviral treatment (2.1% of participants in Dakar, 7.7% in Abidjan and 21.6% in Lome, P=.001) and 59 (53.4%) for close monitoring due to the presence of significant liver fibrosis, elevated ALT or significant HBV replication. CONCLUSIONS Among vulnerable populations in West Africa, a minority of HBV-infected individuals were eligible for immediate antiviral therapy. Prospective cohort studies are necessary to evaluate anti-HBV treatment eligibility facing the significant proportion of individuals with active chronic HBV infection.
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Affiliation(s)
- Antoine Jaquet
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | | | - Judicaël Tine
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Senegal
| | - Aristophane Tanon
- Service de maladies infectieuses et tropicales, CHU de Treichville, Abidjan, Cote d’Ivoire
| | - Camille Anoma
- ONG Clinique de Confiance d’Abidjan, Abidjan, Cote d’Ivoire
| | | | - Alain Attia
- Service de hépato-gastroentérologie, CHU de Yopougon, Abidjan, Cote d’Ivoire
| | - Didier K. Ekouevi
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France,Programme PACCI, CHU de Treichville, Abidjan, Cote d’Ivoire,Département de Santé Publique, Faculté des Sciences de la santé, Université de Lome, Lome, Togo
| | - Moussa Seydi
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Senegal
| | - François Dabis
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France,Inserm, ISPED, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Gilles Wandeler
- Service de maladies infectieuses et tropicales, CRCF, CHU de Fann, Dakar, Senegal,Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland,Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Hassan MA, Kim WR, Li R, Smith CI, Fried MW, Sterling RK, Ghany MG, Wahed AS, Ganova-Raeva LM, Roberts LR, Lok ASF. Characteristics of US-Born Versus Foreign-Born Americans of African Descent With Chronic Hepatitis B. Am J Epidemiol 2017; 186:356-366. [PMID: 28525625 DOI: 10.1093/aje/kwx064] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/14/2016] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus (HBV) infection is more common in African Americans than in white Americans. We compared the epidemiologic, clinical, and virological characteristics of US-born African Americans (USAAs) to those of foreign-born African Americans (FBAAs) with chronic hepatitis B. The adult cohort study of the Hepatitis B Research Network enrolls patients with HBV infection from 21 clinical sites in the United States and Canada. A total of 237 (15%) of the adult participants with chronic HBV infection that were enrolled from January 20, 2011, to October 2, 2013, were of African descent, including 57 USAAs and 180 FBAAs (76%). Compared with FBAAs, USAAs were older and more likely to have acquired HBV through sexual exposure, to be HBeAg-positive, to have higher HBV DNA levels, and to be infected with HBV genotype A2. FBAAs from West Africa were more likely to have elevated serum alanine aminotransferase (72% vs. 50%; P < 0.01) and higher HBV DNA levels (median, 3.2 log10 IU/mL vs. 2.8 log10 IU/mL; P = 0.03) compared with East African FBAAs. The predominant HBV genotype among West African FBAAs was E (67%), whereas genotypes A (78%) and D (16%) were common in East African FBAAs. Significant differences were found between USAAs and FBAAs, highlighting the need for tailored strategies for prevention and management of chronic HBV infection for African Americans.
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66
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Sugarman J, Revill P, Zoulim F, Yazdanpanah Y, Janssen HLA, Lim SG, Lewin SR. Ethics and hepatitis B cure research. Gut 2017; 66:389-392. [PMID: 27849559 DOI: 10.1136/gutjnl-2016-313009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter Revill
- Victorian Infectious Diseases Reference Laboratory, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Fabien Zoulim
- INSERM, Cancer Research Center of Lyon, Hospices Civils de Lyon, Lyon University, Lyon, France
| | - Yazdan Yazdanpanah
- INSERM, Infection Antimicrobials Modelling Evolution, University of Paris Diderot, Hôpital Bichat, Paris, France
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, University Health Network, Toronto General Hospital, Toronto, Canada
| | - Seng Gee Lim
- Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
| | - Sharon R Lewin
- The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Melbourne, Australia
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67
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Hassemer M, Finkernagel M, Peiffer KH, Glebe D, Akhras S, Reuter A, Scheiblauer H, Sommer L, Chudy M, Nübling CM, Hildt E. Comparative characterization of hepatitis B virus surface antigen derived from different hepatitis B virus genotypes. Virology 2017; 502:1-12. [PMID: 27951436 DOI: 10.1016/j.virol.2016.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/28/2016] [Accepted: 12/02/2016] [Indexed: 02/07/2023]
Abstract
For human hepatitis B virus eight distinct and two candidate genotypes are described. These genotypes differ with respect to geographic distribution, molecular virology and virus-associated pathogenesis. Comparative analysis of HBV genotypes revealed, with exception of HBV/G that shows impaired HBsAg release, that no fundamental disparities between genotypes exist regarding glycosylation, subcellular distribution, release of HBsAg and formation of subviral particles. However, there are distinctions regarding the proportion of L to M to S HBs proteins detected intra- and extracellularly for different genotypes. 2D electrophoresis revealed different posttranslational modification patterns for LHBs. In light of the relevance of HBsAg as diagnostic marker, detectability of purified recombinant HBsAg of various genotypes by HBsAg-specific detection systems licensed in Europe was investigated, showing similar sensitivities for genotypes included in this analysis. These data indicate that recombinant HBsAg reproducibly purified following a defined protocol might be used as an alternative to reference materials currently established.
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Affiliation(s)
| | | | - Kai-Henrik Peiffer
- University Hospital Frankfurt, Frankfurt/Main, Germany; Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Dieter Glebe
- Justus Liebig University, Institute of Medical Virology, Gießen, Germany; German Center for Infection Research (DZIF), Gießen-Marburg-Langen, Germany
| | - Sami Akhras
- Paul-Ehrlich-Institut, Department of Virology, Langen, Germany
| | - Andreas Reuter
- Paul-Ehrlich-Institut, Department of Allergology, Langen, Germany
| | | | - Lisa Sommer
- University Hospital Frankfurt, Frankfurt/Main, Germany; Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Michael Chudy
- Paul-Ehrlich-Institut, Department of Virology, Langen, Germany
| | - C Micha Nübling
- Paul-Ehrlich-Institut, Department of Virology, Langen, Germany
| | - Eberhard Hildt
- Paul-Ehrlich-Institut, Department of Virology, Langen, Germany; German Center for Infection Research (DZIF), Gießen-Marburg-Langen, Germany.
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68
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Hundie GB, Stalin Raj V, Gebre Michael D, Pas SD, Koopmans MP, Osterhaus ADME, Smits SL, Haagmans BL. A novel hepatitis B virus subgenotype D10 circulating in Ethiopia. J Viral Hepat 2017; 24:163-173. [PMID: 27808472 DOI: 10.1111/jvh.12631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
Abstract
Hepatitis B virus (HBV) is genetically highly divergent and classified in ten genotypes and forty subgenotypes in distinct ethno-geographic populations worldwide. Ethiopia is a country with high HBV prevalence; however, little is known about the genetic variability of HBV strains that circulate. Here, we characterize the complete genome of 29 HBV strains originating from five Ethiopian regions, by 454 deep sequencing and Sanger sequencing. Phylogenetically, ten strains were classified as genotype A1 and nineteen as genotype D. Fifteen genotype D strains, provisionally named subgenotype D10, showed a novel distinct cluster supported by high bootstrap value and >4% nucleotide divergence from other known subgenotypes. In addition, the novel D10 strains harboured nine unique amino acid signatures in the surface, polymerase and X genes. Seventy-two per cent of the genotype D strains had the precore premature stop codon G1896A. In addition, 63% genotype A and 33% genotype D strains had the basal core promoter mutations, A1762T/G1764A. Furthermore, four pre-S deletion variants and two recombinants were identified in this study. In conclusion, we identified a novel HBV subgenotype D10 circulating in Ethiopia, underlining the high genetic variability of HBV strains in Africa.
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Affiliation(s)
- G B Hundie
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - V Stalin Raj
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - D Gebre Michael
- National blood bank services, Ministry of Health, Addis Ababa, Ethiopia
| | - S D Pas
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M P Koopmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A D M E Osterhaus
- Artemis One health, Utrecht, The Netherlands.,Center for Infection Medicine and Zoonoses Research, University of Veterinary Medicine, Hannover, Germany
| | - S L Smits
- ViroClinics BioScience BV, Rotterdam, The Netherlands
| | - B L Haagmans
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
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69
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Kao JH, Asselah T, Dou XG, Hamed K. Telbivudine therapy for chronic hepatitis B: A journey to identify super-responders and to optimize treatment using the roadmap model. J Gastroenterol Hepatol 2017; 32:73-81. [PMID: 27515408 DOI: 10.1111/jgh.13512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 02/06/2023]
Abstract
Hepatitis B virus (HBV) infection is one of the most serious health problems worldwide with a high risk for cirrhosis and liver cancer. Several antiviral agents have been approved for the treatment of chronic hepatitis B, leading to a rapid reduction in HBV DNA and normalization of serum alanine aminotransferase levels. Telbivudine, a potent inhibitor of HBV replication, has been shown to be well tolerated. Because of the emergence of drug resistance, optimization strategies for telbivudine therapy have been shown to improve patient responses. Optimal baseline characteristics in so-called super-responders have been used to predict the virological response. Baseline HBV DNA levels < 9 log10 copies/mL (2 × 108 IU/mL) or alanine aminotransferase levels of more than or equal to twofold the upper limit of normal in HBeAg-positive patients and HBV DNA < 7 log10 copies/mL (2 × 106 IU/mL) in HBeAg-negative patients were strong predictors for virological response. In addition, the roadmap model, based on early virological response at week 24 of therapy, is considered as a powerful tool to identify patients at risk of treatment failure (HBV DNA ≥ 300 copies/mL, i.e. 60 IU/mL) and to reduce the risk of antiviral resistance. When considering pre-treatment characteristics and on-treatment responses, telbivudine may provide physicians with a wide choice of options to effectively treat patients with chronic hepatitis B, especially those with or at risk of renal impairment, or women of childbearing age.
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Affiliation(s)
- Jia-Horng Kao
- Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Tarik Asselah
- Hepatology Department, AP-HP, Beaujon Hospital, University Paris Diderot and INSERM UMR1149, Centre de Recherche sur l'inflammation, Labex INFLAMEX, Clichy, France
| | - Xiao-Guang Dou
- Department of Infectious Disease, Shengjing Hospital, China Medical University, Shenyang, China
| | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
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70
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Lee HW, Park JY, Ahn SH. An evaluation of entecavir for the treatment of chronic hepatitis B infection in adults. Expert Rev Gastroenterol Hepatol 2016; 10:177-86. [PMID: 26610256 DOI: 10.1586/17474124.2016.1125781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Entecavir is a nucleoside analogue of 2'-deoxyguanosine whose intracellular triphosphate form inhibits replication of the hepatitis B virus. Entecavir is recommended as a first-line monotherapy option for nucleos(t)ide-naïve patients with HBeAg-positive or -negative chronic hepatitis B infection. Entecavir has a three-step mechanism of action: It maintains viral suppression with a greater than 90% chance of undetectable hepatitis B virus DNA during continuous therapy, improves liver histology, and reduces the risk of liver failure or hepatocellular carcinoma development. The safety profile of long-term entecavir therapy is favorable; however, its optimal treatment duration is unknown. Entecavir monotherapy is not a rescue option for patients with lamivudine/adefovir resistance or baseline lamivudine-resistant mutants; rather, combination treatment is recommended for patients with lamivudine/adefovir resistance.
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Affiliation(s)
- Hye Won Lee
- a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea.,b Yonsei Liver Center , Severance hospital , Seoul , Korea
| | - Jun Yong Park
- a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea.,b Yonsei Liver Center , Severance hospital , Seoul , Korea.,c Institute of Gastroenterology , Yonsei University College of Medicine , Seoul , Korea
| | - Sang Hoon Ahn
- a Department of Internal Medicine , Yonsei University College of Medicine , Seoul , Korea.,b Yonsei Liver Center , Severance hospital , Seoul , Korea.,c Institute of Gastroenterology , Yonsei University College of Medicine , Seoul , Korea.,d Brain Korea 21 Project for Medical Science , Seoul , Korea
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71
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Kim HS, Kim BK, Kim SU, Park JY, Kim DY, Song KJ, Park JW, Kim YJ, Baatarkhuu O, Han KH, Ahn SH. Association Between Level of Fibrosis, Rather Than Antiviral Regimen, and Outcomes of Patients With Chronic Hepatitis B. Clin Gastroenterol Hepatol 2016; 14:1647-1656.e6. [PMID: 27305847 DOI: 10.1016/j.cgh.2016.05.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/27/2016] [Accepted: 05/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We performed a propensity-score matched analysis to investigate whether entecavir, compared with lamivudine, can reduce risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B after adjusting for level of fibrosis. METHODS We performed a retrospective study of 1079 patients with chronic hepatitis B who received first-line therapy with lamivudine (n = 435) or entecavir (n = 644) from 2006 through 2013. Only patients with available liver stiffness value measured by transient elastography were recruited. Liver cirrhosis was diagnosed by ultrasonography. To adjust for the imbalance of patients treated with lamivudine versus entecavir, we performed propensity-score matching (PSM), at a ratio of 1:1, using 7 factors (age, sex, hepatitis B e antigen, alanine aminotransferase, serum albumin, platelet count, and liver stiffness; PSM1) or 8 factors (variables of PSM1 plus ultrasonography measurements of cirrhosis; PSM2). Patients with virologic breakthrough or resistance mutations received rescue therapy. RESULTS Over the 7-year period, 91 patients developed HCC and 104 had liver-related events in the entire cohort. In multivariate analyses, level of fibrosis, but not antiviral regimen, was independently associated with risk of HCC (P < .05). The PSM1 group included 342 pairs of patients and the PSM2 group included 338 pairs. Similar proportions of patients given lamivudine versus entecavir developed HCC in each model (10.5% given lamivudine vs 9.9% given entecavir in PSM1 and 11.9% vs 12.6% in PSM2; all P > .05). When PSM was applied to patients with liver stiffness value ≤13 kPa or >13 kPa, patients given lamivudine versus entecavir still had similar cumulative rates of HCC development (all P > .05). CONCLUSIONS In a PSM analysis, we associated level of fibrosis, rather than antiviral regimen, with risk of HCC, when patients received appropriate rescue therapy in case of virologic breakthrough or resistance mutations.
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Affiliation(s)
- Hye Soo Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Jun Song
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yeong Jin Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Oidov Baatarkhuu
- Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
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72
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In Vitro Studies Show that Sequence Variability Contributes to Marked Variation in Hepatitis B Virus Replication, Protein Expression, and Function Observed across Genotypes. J Virol 2016; 90:10054-10064. [PMID: 27512071 DOI: 10.1128/jvi.01293-16] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 08/02/2016] [Indexed: 01/05/2023] Open
Abstract
The hepatitis B virus (HBV) exists as 9 major genotypes (A to I), one minor strain (designated J) and multiple subtypes. Marked differences in HBV natural history, disease progression and treatment response are exhibited by many of these genotypes and subtypes. For example, HBV genotype C is associated with later hepatitis B e antigen (HBeAg) seroconversion and high rates of liver cancer compared to other HBV genotypes, whereas genotype A2 is rarely associated with HBeAg-negative disease or liver cancer. The reasons for these and other differences in HBV natural history are yet to be determined but could in part be due to sequence differences in the HBV genome that alter replicative capacity and/or gene expression. Direct comparative studies on HBV replication and protein expression have been limited to date due largely to the absence of infectious HBV cDNA clones for each of the HBV genotypes present in the same genetic arrangement. We have produced replication-competent infectious cDNA clones of the most common subtypes of genotypes A to D, namely, A2, B2, C2, D3, and the minor strain J, and compared their HBV replication phenotype using transient-transfection models. We identified striking differences in HBV replicative capacity as well as HBeAg and surface (HBsAg) protein expression across genotypes, which may in part be due to sequence variability in regulatory regions of the HBV genome. Functional analysis showed that sequence differences in the major upstream regulatory region across genotypes impacted promoter activity. IMPORTANCE There have been very few studies directly comparing the replication phenotype of different HBV genotypes, for which there are marked differences in natural history and disease progression worldwide. We have generated replication-competent 1.3-mer cDNA clones of the major genotypes A2, B2, C2, and D3, as well as a recently identified strain J, and identified striking differences in replicative capacity and protein expression that may contribute to some of the observed differences in HBV natural history observed globally.
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73
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Revill P, Locarnini S. Antiviral strategies to eliminate hepatitis B virus covalently closed circular DNA (cccDNA). Curr Opin Pharmacol 2016; 30:144-150. [DOI: 10.1016/j.coph.2016.08.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/23/2016] [Accepted: 08/28/2016] [Indexed: 02/08/2023]
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74
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Park JY, Kim CW, Bae SH, Jung KS, Kim HY, Yoon SK, Han KH, Ahn SH. Entecavir plus tenofovir combination therapy in patients with multidrug-resistant chronic hepatitis B: results of a multicentre, prospective study. Liver Int 2016; 36:1108-15. [PMID: 26781724 DOI: 10.1111/liv.13059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/25/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Sequential therapy posed a high risk of emergence of multidrug resistance and presented a management issue in chronic hepatitis B (CHB) treatment. We evaluated the antiviral efficacy and safety of entecavir (ETV) plus tenofovir (TDF) combination therapy in multidrug-resistant (MDR) CHB patients. METHODS In this prospective, multicentre study, MDR CHB patients, defined as measurable serum HBV DNA (≥60 IU/ml) while on any rescue treatment regimen for at least 24 weeks and the presence of documented prior genotypic resistance to both nucleoside analogue(s) and nucleotide analogue, were treated with ETV 1.0 mg and TDF 300 mg combination therapy for 48 weeks. RESULTS A total of 64 eligible patients who had previously failed to a median three lines of antiviral therapy (range, 2-6) were included. At baseline, median age was 47.0 years, 89.1% were HBeAg(+), and median HBV DNA was 4.24 (range, 2.11-6.73) log10 IU/ml. By week 4, 12, 24 and 48, 15/64 (23.4%), 36/64 (56.3%), 43/64 (67.2%) and 55/64 (85.9%) patients achieved a HBV DNA <60 IU/ml respectively. The mean reduction of HBV DNA from baseline to 4 and 48 weeks was 1.23 log10 IU/ml and 2.38 log10 IU/ml respectively. Although five patients experienced virological breakthrough, all were transient and no resistant mutation to TDF or novel mutation was detected in any patients. CONCLUSIONS In difficult-to-treat MDR CHB patients with a high exposure to multiple antiviral drugs, ETV plus TDF combination therapy can provide a very high rate of viral suppression through 48 weeks of treatment.
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Affiliation(s)
- Jun Yong Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Chang Wook Kim
- Liver Cirrhosis Clinical Research Center, Seoul, Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Si Hyun Bae
- Liver Cirrhosis Clinical Research Center, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Sik Jung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Hee Yeon Kim
- Liver Cirrhosis Clinical Research Center, Seoul, Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | - Seung Kew Yoon
- Liver Cirrhosis Clinical Research Center, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Liver Cirrhosis Clinical Research Center, Seoul, Korea
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75
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Tsuzuki Y, Watanabe T, Iio E, Fujisaki S, Ibe S, Kani S, Hamada-Tsutsumi S, Yokomaku Y, Iwatani Y, Sugiura W, Okuse C, Okumura A, Sato Y, Tanaka Y. Virological characteristics of hepatitis B genotype G/A2 recombination virus in Japan. Hepatol Res 2016; 46:775-83. [PMID: 26517979 DOI: 10.1111/hepr.12612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/25/2015] [Accepted: 10/18/2015] [Indexed: 12/30/2022]
Abstract
AIM We identified four cases of infection with hepatitis B virus genotype G and A2 recombinant (HBV/G/A2) strains, which were initially overlooked by enzyme immunoassay-based genotyping. The patients were all men who have sex with men (MSM) and inhabited several metropolitan areas of Japan, suggesting that the recombinant strains may be circulating among high-risk groups such as MSM. Here, we investigated the genomic structure and virological properties of the HBV/G/A2 strains. METHODS Complete genome sequences of the isolates were determined and phylogenetically analyzed. Replication efficiency of HBV/G/A2 was investigated by transfecting plasmids containing 1.24-fold viral genome. The in vivo viral kinetics of HBV/G/A2 were investigated using chimeric mice with humanized livers. RESULTS Phylogenetic analysis revealed that the four strains were almost identical (>99.7% homologous). The preS2/S region of these strains was highly homologous to that of genotype A2 and the remaining region was almost identical to that of genotype G, reflecting inter-genotypic recombination. Interestingly, in all four cases, genotype A was co-infected as a minor population. In vitro analysis revealed that HBV/G/A2 had a low replication rate. Although detectable viremia was not measurable following the inoculation of HBV/G/A2 into chimeric mice, subsequent superinfection of HBV genotype A greatly enhanced HBV/G/A2 replication and viral spread. CONCLUSION We found that four cases of HBV/G/A2 recombinant among MSM patients in the metropolitan areas of Japan, and HBV/A co-infections are required for its efficient replication. High-risk groups such as MSM should be carefully tested for infection of genotype G-derived variants.
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Affiliation(s)
- Yuji Tsuzuki
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Clinical Laboratory, Nagoya City University Hospital, Nagoya, Japan
| | - Tsunamasa Watanabe
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Division of Gastroenterology and Hepatology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Etsuko Iio
- Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Seiichiro Fujisaki
- Department of Infectious Diseases and Immunology Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shiro Ibe
- Department of Infectious Diseases and Immunology Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Satomi Kani
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Clinical Laboratory, Nagoya City University Hospital, Nagoya, Japan
| | - Susumu Hamada-Tsutsumi
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshiyuki Yokomaku
- Department of Infectious Diseases and Immunology Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Yasumasa Iwatani
- Department of Infectious Diseases and Immunology Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Wataru Sugiura
- Department of Infectious Diseases and Immunology Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Chiaki Okuse
- Division of Gastroenterology and Hepatology, St Marianna University School of Medicine, Kawasaki, Japan
| | - Akihiko Okumura
- Division of Gastroenterology, Aichi Medical University, Nagakute, Japan.,Department of Gastroenterology, Kainan Hospital, Yatomi, Japan
| | - Yoshihisa Sato
- Department of Internal Medicine, Kyorin University School of Medicine, Mitaka, Japan
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Clinical Laboratory, Nagoya City University Hospital, Nagoya, Japan
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76
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Molecular Evolution and Phylodynamics of Acute Hepatitis B Virus in Japan. PLoS One 2016; 11:e0157103. [PMID: 27280441 PMCID: PMC4900519 DOI: 10.1371/journal.pone.0157103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 05/24/2016] [Indexed: 12/11/2022] Open
Abstract
Hepatitis B virus (HBV) is prevalent worldwide and causes liver diseases, including acute and chronic hepatitis. Ten HBV genotypes (A–J) with distinct geographic distributions have been reported. Cases of acute HBV infection with genotype A have increased in Japan nationwide since the 1990s, mainly through sexual transmission. To investigate the molecular evolution and phylodynamics of HBV genotypes, we collected acute HBV isolates acquired in Japan from 1992–2002. Full genomes were obtained for comprehensive phylogenetic and phylodynamic analysis, with other Japanese HBV sequences from GenBank that were isolated during 1991–2010. HBV genotypes were classified using the maximum-likelihood and Bayesian methods. The GMRF Bayesian Skyride was used to estimate the evolution and population dynamics of HBV. Four HBV genotypes (A, B, C, and H) were identified, of which C was the major genotype. The phylodynamic results indicated an exponential growth between the 1960s and early 1990s; this was followed by a population bottleneck after 1995, possibly linked with successful implementation of a nationwide vaccination program. However, HBV/A increased from 1990 to 2003–2004, and then started to decrease. The prevalence of genotype A has increased over the past 10 years. Phylodynamic inference clearly demonstrates a steady population growth compatible with an ongoing subepidemic; this might be due to the loss of immunity to HBV in adolescents and people being born before the vaccination program. This is the first phylodynamic study of HBV infection in Japan and will facilitate understanding the molecular epidemiology and long-term evolutionary dynamics of this virus in Japan.
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77
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Godoy BA, Gomes-Gouvêa MS, Zagonel-Oliveira M, Alvarado-Mora MV, Salzano FM, Pinho JRR, Fagundes NJR. High prevalence of HBV/A1 subgenotype in native south Americans may be explained by recent economic developments in the Amazon. INFECTION GENETICS AND EVOLUTION 2016; 43:354-63. [PMID: 27267305 DOI: 10.1016/j.meegid.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 12/15/2022]
Abstract
Native American populations present the highest prevalence of Hepatitis B Virus (HBV) infection in the Americas, which may be associated to severe disease outcomes. Ten HBV genotypes (A–J) have been described, displaying a remarkable geographic structure, which most likely reflects historic patterns of human migrations. In this study, we characterize the HBV strains circulating in a historical sample of Native South Americans to characterize the historical viral dynamics in this population. The sample consisted of 1070 individuals belonging to 38 populations collected between 1965 and 1997. Presence of HBV DNA was checked by quantitative real-time PCR, and determination of HBV genotypes and subgenotypes was performed through sequencing and phylogenetic analysis of a fragment including part of HBsAg and Pol coding regions (S/Pol). A Bayesian Skyline Plot analysis was performed to compare the viral population dynamics of HBV/A1 strains found in Native Americans and in the general Brazilian population. A total of 109 individuals were positive for HBV DNA (~ 10%), and 70 samples were successfully sequenced and genotyped. Subgenotype A1 (HBV/A1), related to African populations and the African slave trade, was the most prevalent (66–94%). The Skyline Plot analysis showed a marked population expansion of HBV/A1 in Native Americans occurring more recently (1945–1965) than in the general Brazilian population. Our results suggest that historic processes that contributed to formation of HBV/A1 circulating in Native American are related with more recent migratory waves towards the Amazon basin, which generated a different viral dynamics in this region.
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Affiliation(s)
- Bibiane A Godoy
- Genetics Department, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Michele S Gomes-Gouvêa
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Marcelo Zagonel-Oliveira
- Genetics Department, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; VIZLab - Advanced Visualization Laboratory, UNISINOS, São Leopoldo, RS, Brazil
| | - Mónica V Alvarado-Mora
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Francisco M Salzano
- Genetics Department, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - João R R Pinho
- Laboratory of Tropical Gastroenterology and Hepatology "João Alves de Queiroz and Castorina Bittencourt Alves", Institute of Tropical Medicine, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson J R Fagundes
- Genetics Department, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
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Abstract
Chronic HBV infection results in >1 million deaths per year from cirrhosis and liver cancer. No known cure for chronic HBV exists, due in part to the continued presence of transcriptionally active DNA in the nucleus that is not directly targeted by current antiviral therapies. A coordinated approach is urgently needed to advance an HBV cure worldwide, such as those established in the HIV field. We propose the establishment of an International Coalition to Eliminate Hepatitis B Virus (ICE-HBV) to facilitate the formation of international working groups on HBV virology, immunology, innovative tools and clinical trials: to promote awareness and education as well as to drive changes in government policy and ensure funds are channelled to HBV cure research and drug development. With the ICE-HBV in place, it should be possible to enable a HBV cure within the next decade.
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79
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Tong S, Revill P. Overview of hepatitis B viral replication and genetic variability. J Hepatol 2016; 64:S4-S16. [PMID: 27084035 PMCID: PMC4834849 DOI: 10.1016/j.jhep.2016.01.027] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 02/06/2023]
Abstract
Chronic infection with hepatitis B virus (HBV) greatly increases the risk for liver cirrhosis and hepatocellular carcinoma (HCC). HBV isolates worldwide can be divided into ten genotypes. Moreover, the immune clearance phase selects for mutations in different parts of the viral genome. The outcome of HBV infection is shaped by the complex interplay of the mode of transmission, host genetic factors, viral genotype and adaptive mutations, as well as environmental factors. Core promoter mutations and mutations abolishing hepatitis B e antigen (HBeAg) expression have been implicated in acute liver failure, while genotypes B, C, subgenotype A1, core promoter mutations, preS deletions, C-terminal truncation of envelope proteins, and spliced pregenomic RNA are associated with HCC development. Our efforts to treat and prevent HBV infection are hampered by the emergence of drug resistant mutants and vaccine escape mutants. This paper provides an overview of the HBV life cycle, followed by review of HBV genotypes and mutants in terms of their biological properties and clinical significance.
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Affiliation(s)
- Shuping Tong
- Liver Research Center, Rhode Island Hospital, The Alpert Warren School of Medicine, Brown University, Providence, RI, USA; Key Laboratory of Medical Molecular Virology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Peter Revill
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, VIC, Australia ()
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Li Q, Song J, Huang Y, Li X, Zhuo Q, Li W, Chen C, Lu C, Qi X, Chen L. The Gamma-Glutamyl-Transpeptidase to Platelet Ratio Does not Show Advantages than APRI and Fib-4 in Diagnosing Significant Fibrosis and Cirrhosis in Patients With Chronic Hepatitis B: A Retrospective Cohort Study in China. Medicine (Baltimore) 2016; 95:e3372. [PMID: 27100421 PMCID: PMC4845825 DOI: 10.1097/md.0000000000003372] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The gamma-glutamyl-transpeptidase to platelet ratio (GPR) is a new liver fibrosis model, which is reported to be more accurate than aspartate transaminase (AST) to platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for diagnosing significant fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) in West Africa. The aim of this study is to assess the diagnostic accuracy of GPR for significant fibrosis and cirrhosis in Chinese CHB patients, and explore whether GPR deserves to be popularized in China. A total of 372 CHB patients who underwent liver biopsies and routine laboratory tests were retrospectively studied. The Scheuer scoring system was adopted as the pathological standard of liver fibrosis. Using liver histology as a gold standard, the diagnostic accuracies of GPR, APRI, and Fib-4 for significant fibrosis and cirrhosis are evaluated and compared by the receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of these 372 patients, 176 (47.3%), 129 (34.7%), and 72 (19.4%) were classified as having significant fibrosis (≥ S2), severe fibrosis (≥ S3), and cirrhosis (S4), respectively. The AUROCs of GPR for significant fibrosis (0.72 vs. 0.78; P = 0.01), severe fibrosis (0.75 vs. 0.80; P = 0.04), and cirrhosis (0.78 vs. 0.83; P = 0.02) were lower than those of APRI. The AUROCs of GPR and Fib-4 for diagnosing significant fibrosis (0.72 vs. 0.70; P = 0.29), severe fibrosis (0.75 vs. 0.73; P = 0.33), and cirrhosis (0.78 vs. 0.75; P = 0.38) were comparable. GPR is a new serum diagnostic model for liver fibrosis and cirrhosis, but does not show advantages than APRI and Fib-4 in identifying significant fibrosis, severe fibrosis, and cirrhosis in CHB patients in China.
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Affiliation(s)
- Qiang Li
- From the Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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81
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Visvanathan K, Lang T, Ryan K, Wilson R, Skinner NA, Thompson AJV, Ahn SH, Weilert F, Abbott W, Gane E, Colledge D, Li K, Locarnini S, Mansell A, Revill PA. Toll-IL1 receptor-mediated innate immune responses vary across HBV genotype and predict treatment response to pegylated-IFN in HBeAg-positive CHB patients. J Viral Hepat 2016; 23:170-9. [PMID: 26436722 DOI: 10.1111/jvh.12477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/30/2015] [Indexed: 12/18/2022]
Abstract
Patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) have suppressed TLR2 expression, function and cytokine production. The aim of this study was to explore the importance of hepatitis B virus (HBV) genotype in innate immune responses and investigate whether Toll-like receptor (TLR) expression/function has potential roles as predictive biomarkers of successful therapy with pegylated interferon (Peg-IFN) therapy of HBeAg seroconversion in HBeAg-positive patients. We showed that as early as 4 weeks after initiation of Peg-IFN, future HBeAg seroconverters had significantly elevated levels of TLR2 expression on monocytes. TLR2-associated IL-6 production at baseline and week 4 of therapy and TLR4 IL-6 production at week 4 were also markedly elevated in HBeAg seroconverters. HBV genotype also influenced treatment response, with genotypes A and B more likely to seroconvert than D. We were able to demonstrate that these differences were due in part to the interaction of the specific HBeAg proteins with TLR pathway adaptor molecules, and these interactions were genotype dependent. HBeAg-mediated modulation of TLR signalling was also observed in Huh7 cells, following stimulation with Pam3Cys. Importantly, the addition of IFN-α to TLR2-stimulated cells cotransfected with an HBeAg expression plasmid reversed HBeAg-mediated suppression of hepatocytes. These findings demonstrate that patients with an activated inflammatory response are much more likely to respond to IFN therapy, with TLR responses showing promise as potential biomarkers of HBeAg seroconversion in this setting. Furthermore, our findings suggest there is differential genotype-specific HBeAg suppression of innate signalling pathways which may account for some of the clinical differences observed across the CHB spectrum.
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Affiliation(s)
- K Visvanathan
- Department of Medicine, Monash University (MMC), Melbourne, Vic., Australia
| | - T Lang
- Monash Institute of Medical Research, Clayton, Vic., Australia
| | - K Ryan
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia
| | - R Wilson
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia
| | - N A Skinner
- Department of Medicine, Monash University (MMC), Melbourne, Vic., Australia
| | - A J V Thompson
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Vic., Australia
| | - S H Ahn
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - F Weilert
- New Zealand Liver Transplant Unit, Auckland, New Zealand
| | - W Abbott
- New Zealand Liver Transplant Unit, Auckland, New Zealand
| | - E Gane
- New Zealand Liver Transplant Unit, Auckland, New Zealand
| | - D Colledge
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia
| | - K Li
- Department of Microbiology, Immunology and Biochemistry, University of Tennessee Health Science Centre, Memphis, TN, USA
| | - S Locarnini
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia
| | - A Mansell
- Monash Institute of Medical Research, Clayton, Vic., Australia
| | - P A Revill
- Victorian Infectious Diseases Reference Laboratory, Melbourne, Vic., Australia
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82
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Revill PA, Locarnini SA. New perspectives on the hepatitis B virus life cycle in the human liver. J Clin Invest 2016; 126:833-6. [PMID: 26901815 DOI: 10.1172/jci86650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The central role of the transcriptional template of the hepatitis B virus (HBV), covalently closed circular DNA (cccDNA), has been difficult to study in patients with chronic hepatitis B (CHB) infection. In this issue of the JCI, Zhang and colleagues reveal a mosaic distribution of viral antigens and nucleic acids and a mismatch between HBV cccDNA, RNA, and expression of the hepatitis B surface antigen (HBsAg). These unusual patterns varied over the natural history of CHB, prompting the authors to propose a new three-stage model of the HBV life cycle at the single-cell level.
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83
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Xu R, Chang J, Huang H, Deng ZH, Ji YY. Relationship between clinical parameters and degree of liver fibrosis and risk factors for significant liver fibrosis in patients with chronic hepatitis B: A Logistic regression analysis. Shijie Huaren Xiaohua Zazhi 2016; 24:279-286. [DOI: 10.11569/wcjd.v24.i2.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To investigate the relationship between the severity of fibrosis and clinical parameters in patients with chronic hepatitis B (CHB), and to analyze risk factors for significant liver fibrosis in CHB patients.
METHODS: A total of 76 biopsy-proven CHB cases treated from January 2012 to July 2015 at the Second Hospital Affiliated to Kunming Medical University were included in the study. Gender, age, blood count variables including white blood cells, hemoglobin (HB), platelet count (PLT), red blood cell distribution width (RDW), mean platelet volume (MPV), as well as albumin (ALB), globin (GLO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), total bilirubin (TB), prothrombin time (PT) and serum HBV DNA were recorded. Relationship between these parameters and liver fibrosis stage and risk factors for significant liver fibrosis were analyzed.
RESULTS: With the increase in the severity of liver fibrosis, white blood cells, HB, PLT, and ALB gradually decreased, and RDW, GLB, AST, PT, GGT increased; all of these parameters had significant differences between the S1-S4 groups (P < 0.05). Spearman correlation analysis showed that there was a positive correlation between ALT, AST, GGT, TB, GLO, PT, RDW, MPV, age and liver stage of fibrosis, and a negative correlation between liver stage of fibrosis and ALB, white blood cells, HB, and PLT. In logistic regression analysis, PLT was identified as an independent risk factor for significant liver fibrosis in CHB.
CONCLUSION: ALT is not predictive of liver fibrosis stage. PLT is an independent risk factor for significant liver fibrosis in CHB. Liver histopathology can be recommended for CHB patients with older age, lower PLT, even though ALT is normal or only mildly elevated.
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84
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Revill P, Locarnini S. The Basis for Antiviral Therapy: Drug Targets, Cross-Resistance, and Novel Small Molecule Inhibitors. MOLECULAR AND TRANSLATIONAL MEDICINE 2016. [DOI: 10.1007/978-3-319-22330-8_14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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85
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Martinot-Peignoux M, Marcellin P. Virological and serological tools to optimize the management of patients with chronic hepatitis B. Liver Int 2016; 36 Suppl 1:78-84. [PMID: 26725902 DOI: 10.1111/liv.12998] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 02/06/2023]
Abstract
Molecular biology techniques are routinely used to diagnose and monitor treatment in patients with chronic hepatitis B (CHB). These tools can detect and quantify viral genomes and analyse their sequences to determine genotype. The increasing use of these tools to monitor patients has greatly improved the management of CHB infection by maximizing the potential for individualized treatment. HBV genotyping has become increasingly important and provides additional information to predict a response to therapy. More sensitive methods to determine HBV DNA levels are now available and the units of measurements have been standardized. HBsAg levels in serum have been shown to reflect active intrahepatic covalently closed circular DNA (cccDNA) and to have additional value in treatment decisions, especially as an on-treatment marker.
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Affiliation(s)
- Michelle Martinot-Peignoux
- INSERM, UMR1149, Centre de Recherche sur l'Inflammation, Paris, France.,Université Denis Diderot Paris 7, Paris, France
| | - Patrick Marcellin
- INSERM, UMR1149, Centre de Recherche sur l'Inflammation, Paris, France.,Université Denis Diderot Paris 7, Paris, France.,Service d'Hépatologie, Hôpital Beaujon AP-HP, Clichy Cedex, France
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86
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Zheng L, Li MP, Gou ZP, Wang Y, Xu N, Cai YM, Luo H. A pharmacokinetic and pharmacodynamic comparison of a novel pegylated recombinant consensus interferon-α variant with peginterferon-α-2a in healthy subjects. Br J Clin Pharmacol 2015; 79:650-9. [PMID: 25297637 DOI: 10.1111/bcp.12528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 09/30/2014] [Indexed: 02/05/2023] Open
Abstract
AIMS The aims of the study were to assess the pharmacokinetics, pharmacodynamics, safety and tolerability of a novel, pegylated recombinant human consensus interferon-α variant (PEG-IFN-SA) in healthy volunteers. A pharmacokinetic and pharmacodynamic comparison of PEG-IFN-SA and peginterferon-α-2a in healthy subjects was evaluated. METHODS A randomized, dose-escalating, single administration dose phase I clinical study was conducted. Thirty healthy subjects received PEG-IFN-SA as a single dose of 0.5-2.0 μg kg(-1) by subcutaneous (s.c.) injection in four parallel groups. Eight subjects received peginterferon-α-2a as a single dose of 180 μg s.c. RESULTS The incidence rates of adverse events for PEG-IFN-SA and peginterferon-α-2a were 29 of 30 and 7 of 8, respectively. The adverse events for PEG-IFN-SA were mild to moderate and similar to those of peginterferon-α-2a. Within 168 h after injection, the mean values of maximal concentration and area under the plasma concentration-time curve from time of dosing to 168 h [AUC(0-168h) ] for 2',5'-oligoadenylate, neopterin and β2 -microglobulin for PEG-IFN-SA at 1.5 μg kg(-1 ) s.c. were similar to or higher than those for peginterferon-α-2a at a dose of 180 μg s.c. After s.c. injection of PEG-IFN-SA at 1.5 μg kg(-1) , the mean geometric mean values of plasma half-life, time to maximal concentration, maximal concentration and AUC(0-168h) were 55.3 h, 26.9 h, 0.53 μg l(-1) and 44.0 μg l(-1) h, respectively. CONCLUSIONS The tolerance, pharmacokinetic and pharmacodynamic characteristics of PEG-IFN-SA support its administration by s.c. injection as a single dose of 1.5 μg kg(-1) or at 2.0 μg kg(-1) per week.
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Affiliation(s)
- Li Zheng
- Institute of Clinical Pharmacology/GCP Center, West China Hospital of Sichuan University, Chengdu, 610041, China
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87
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Niller HH, Ay E, Banati F, Demcsák A, Takacs M, Minarovits J. Wild type HBx and truncated HBx: Pleiotropic regulators driving sequential genetic and epigenetic steps of hepatocarcinogenesis and progression of HBV-associated neoplasms. Rev Med Virol 2015; 26:57-73. [PMID: 26593760 DOI: 10.1002/rmv.1864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/30/2015] [Accepted: 10/15/2015] [Indexed: 12/23/2022]
Abstract
Hepatitis B virus (HBV) is one of the causative agents of hepatocellular carcinoma. The molecular mechanisms of tumorigenesis are complex. One of the host factors involved is apparently the long-lasting inflammatory reaction which accompanies chronic HBV infection. Although HBV lacks a typical viral oncogene, the HBx gene encoding a pleiotropic regulatory protein emerged as a major player in liver carcinogenesis. Here we review the tumorigenic functions of HBx with an emphasis on wild type and truncated HBx variants, and their role in the transcriptional dysregulation and epigenetic reprogramming of the host cell genome. We suggest that HBx acquired by the HBV genome during evolution acts like a cellular proto-onc gene that is activated by deletion during hepatocarcinogenesis. The resulting viral oncogene (v-onc gene) codes for a truncated HBx protein that facilitates tumor progression. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hans Helmut Niller
- Institute for Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany
| | - Eva Ay
- Department of Retrovirology, National Center for Epidemiology, Budapest, Hungary
| | - Ferenc Banati
- RT-Europe Nonprofit Research Center, Mosonmagyarovar, Hungary
| | - Anett Demcsák
- University of Szeged, Faculty of Dentistry, Department of Oral Biology and Experimental Dental Research, Szeged, Hungary
| | - Maria Takacs
- Division of Virology, National Center for Epidemiology, Budapest, Hungary
| | - Janos Minarovits
- University of Szeged, Faculty of Dentistry, Department of Oral Biology and Experimental Dental Research, Szeged, Hungary
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88
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Lampertico P, Maini M, Papatheodoridis G. Optimal management of hepatitis B virus infection - EASL Special Conference. J Hepatol 2015; 63:1238-53. [PMID: 26150256 DOI: 10.1016/j.jhep.2015.06.026] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 12/13/2022]
Abstract
There have been great strides in the management of chronic hepatitis B virus (HBV) infection, but considerable challenges remain. The European Association for the Study of the Liver (EASL) convened a special conference focusing on all clinical aspects of the management of this disease. Immigration patterns are having a huge effect on the incidence, prevalence and genotype predominance of HBV in many European countries. In recent years there has been significant progress in our understanding of the virology and immunopathology of HBV, particularly the identification of the entry receptor for HBV conferring its hepatotropism, sodium taurocholate co-transporting polypeptide, and a better understanding of the regulation of the covalently closed circular DNA form of HBV - the major barrier to cure. However, more fundamental scientific research is needed. Serum biomarkers and transient elastography offer equivalent performance in the grading of disease stage and progression and monitoring of treatment. Occult HBV infection is often overlooked, but has many important implications for e.g., immuno-suppression, liver transplantation and the progression and severity of liver diseases from other causes. Hepatitis B e antigen positive immunotolerant patients, who are a significant source of horizontal and vertical transmission, are at risk for developing active chronic hepatitis B, but current treatment options are ineffective. Pegylated interferon therapy, given for a finite duration, offers sustained off-treatment responses in a minority of patients. Nucleos(t)ide analogues suppress the virus, improve liver histological lesions, reverse cirrhosis in the majority of cases, and improve survival, but 'cure' cannot be achieved. There is also a pressing need for novel HBV/hepatitis D virus co-infection therapies. Novel therapeutic strategies, e.g. immunomodulation, RNA interference and viral entry inhibition have demonstrated promising early results.
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Affiliation(s)
- Pietro Lampertico
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Mala Maini
- Division of Infection and Immunity, UCL, London, UK
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89
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Seo YS, Kim MY, Kim SU, Hyun BS, Jang JY, Lee JW, Lee JI, Suh SJ, Park SY, Park H, Jung EU, Kim BS, Kim IH, Lee TH, Um SH, Han KH, Kim SG, Paik SK, Choi JY, Jeong SW, Jin YJ, Lee KS, Yim HJ, Tak WY, Hwang SG, Lee YJ, Lee CH, Kim DG, Kang YW, Kim YS. Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study. Liver Int 2015; 35:2246-55. [PMID: 25682719 DOI: 10.1111/liv.12808] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/09/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS Transient elastography (TE) has become an alternative to liver biopsy (LB). This study investigated the diagnostic performance of liver stiffness (LS) measurement using TE in Korean patients with chronic hepatitis B and C (CHB and CHC). METHODS From April 2006 to June 2014, 916 patients (567 CHB and 349 CHC) who underwent LB and TE at 15 centres were analyzed. The Batts and Ludwig scoring system was used for histologic assessment. Aspartate aminotransferase (AST)-to-platelet ratio indexes (APRI) were calculated. Area under the receiver operating characteristic curve (AUROC) was used. RESULTS The median age, LS value, and APRI score were 45 years, 8.8 kPa, and 0.61, respectively, in CHB patients vs. 51 years, 6.8 kPa and 0.55, respectively, in CHC patients. TE was significantly superior to APRI in CHB patients (AUROC 0.774 vs. 0.72 for ≥F2, 0.849 vs. 0.812 for ≥F3, and 0.902 vs. 0.707 for F4, respectively; all P < 0.05). Furthermore, TE was significantly superior for predicting ≥ F3 stage (AUROC 0.865 vs. 0.840, P = 0.009) whereas it was similar for predicting ≥ F2 and F4 stage (AUROC 0.822 vs. 0.796; 0.910 vs. 0.884; all P > 0.05) in CHC patients. In CHB patients, optimal cut-off LS values were 7.8 kPa for ≥F2, 8.2 kPa for ≥ F3, and 11.6 kPa for F4, vs. 6.8 kPa, 8.6 kPa, and 14.5 kPa, respectively, in CHC patients. CONCLUSIONS TE can accurately assess the degree of liver fibrosis in Korean patients with CVH. TE was superior to APRI for predicting each fibrosis stage.
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Affiliation(s)
- Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, South Korea
| | - Moon Young Kim
- Yonsei University, Wonju College of Medicine, Department of Internal Medicine, Wonju, South Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Bae Si Hyun
- Division of Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jae Young Jang
- Institute for Digestive Research, Digestive Disease Center, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, South Korea
| | - Jin Woo Lee
- Department of Internal Medicine, Division of Hepatology, Inha University School of Medicine, Incheon, South Korea
| | - Jung Il Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Jun Suh
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Soo Young Park
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, South Korea
| | - Hana Park
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Bundang, South Korea
| | - Eun Uk Jung
- Departments of Internal Medicine and Preventive Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Seoul, South Korea
| | - Tae Hee Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University School of Medicine, Daejeon, South Korea
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, South Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Soon Koo Paik
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Young Choi
- Division of Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Soung Won Jeong
- Institute for Digestive Research, Digestive Disease Center, Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul, South Korea
| | - Young Joo Jin
- Department of Internal Medicine, Division of Hepatology, Inha University School of Medicine, Incheon, South Korea
| | - Kwan Sik Lee
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, South Korea
| | - Won Young Tak
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu, South Korea
| | - Seong Gyu Hwang
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Bundang, South Korea
| | - Youn Jae Lee
- Departments of Internal Medicine and Preventive Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Chang Hyeong Lee
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Dae-Ghon Kim
- Department of Internal Medicine, Chonbuk National University Medical School and Hospital, Seoul, South Korea
| | - Young Woo Kang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University School of Medicine, Daejeon, South Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
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90
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Tajik Z, Keyvani H, Bokharaei-Salim F, Zolfaghari MR, Fakhim S, Keshvari M, Alavian SM. Detection of Hepatitis B Virus Covalently Closed Circular DNA in the Plasma of Iranian HBeAg-Negative Patients With Chronic Hepatitis B. HEPATITIS MONTHLY 2015; 15:e30790. [PMID: 26504471 PMCID: PMC4612772 DOI: 10.5812/hepatmon.30790] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/16/2015] [Accepted: 08/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Covalently closed circular DNA (cccDNA) of hepatitis B virus (HBV) is a marker of HBV replication in the liver of patients infected with HBV. OBJECTIVES This study aimed to investigate the association between the presence of cccDNA in the plasma samples of Iranian treatment-naive patients with chronic hepatitis B infection and HBV viral load and HBsAg levels. PATIENTS AND METHODS From April 2012 to May 2015, 106 treatment-naive patients with chronic hepatitis B infection were enrolled in this cross-sectional study. The HBsAg titer was measured by the Roche HBsAg II assay on the Cobas e411 system, and HBV DNA quantitation was performed using the COBAS TaqMan 48 kit. Real-time polymerase chain reaction was performed for the detection of HBV cccDNA. RESULTS The mean (SD) age of the patients was 41.1 ± 12.4 years (range, 20 - 62 years). From a total of 106 study participants, 67 (63.2%) were males. The HBV cccDNA was detected in plasma specimens in 19 (17.9%) out of the total 106 patients, and a significant relationship was found between the presence of cccDNA in plasma sample of males (23.9%) and females (7.7%) (P = 0.039). Also, a significant correlation was found between the presence of cccDNA in plasma sample of the patients and HBV viral load level (P < 0.0001) and HBsAg titer (P = 0.0043). CONCLUSIONS This study showed that cccDNA can be detected in the plasma specimen of 17.9% of Iranian treatment-naive patients with chronic hepatitis B infection. Therefore, designing prospective studies focusing on the detection of cccDNA in these patients would provide more information.
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Affiliation(s)
- Zahra Tajik
- Department of Microbiology, Faculty of Basic Sciences, Qom Branch, Islamic Azad University, Qom, IR Iran
| | - Hossein Keyvani
- Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran
| | - Farah Bokharaei-Salim
- Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran
- HIV Laboratory of National Center, Deputy of Health, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Farah Bokharaei-Salim, Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188602205, E-mail:
| | - Mohammad Reza Zolfaghari
- Department of Microbiology, Faculty of Basic Sciences, Qom Branch, Islamic Azad University, Qom, IR Iran
| | - Shahin Fakhim
- Department of Civil Engineering, Faculty of Engineering, Payame Noor University, Karaj, IR Iran
| | - Maryam Keshvari
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Middle East Liver Disease Center, Tehran, IR Iran
- Iran Hepatitis Network, Tehran, IR Iran
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91
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Abstract
INTRODUCTION The hepatitis B virus (HBV) causes chronic hepatitis B (CHB) in ∼350 million people worldwide who have an increased risk of end-stage liver disease and/or hepatocellular carcinoma. SOURCES OF DATA Several peer-reviewed papers featuring new approaches to anti-HBV management. Additionally, we also reviewed recent abstract presentations at international congresses. AREAS OF AGREEMENT There has been great progress in CHB therapy with the development of standard and pegylated interferon (i.e. PEG-IFN) as well as nucleos/tide analogs (NAs). IFN has both antiviral and immunomodulatory effects and through immune-mediated destruction of infected hepatocytes offers the possibility of finite therapy. However, this 'killing for a cure' antiviral strategy may not be tolerated in many, especially in cirrhotic patients. NAs inhibit viral reverse transcriptase, have few side effects and prevent liver disease progression, but cannot offer a cure as they have little effect on the resilient HBV covalently closed circular DNA (cccDNA) intermediate. Moreover, NAs such as tenofovir and entecavir offer a high genetic barrier to resistance, but are expensive and not readily available in many global regions. GROWING POINTS Despite significant treatment advances, there is increased recognition of the need for improved anti-HBV treatments, and new virologic tests for monitoring treatment response. AREAS OF CONTROVERSY The role of quantitative hepatitis B surface antigen, intrahepatic cccDNA levels and viral genotype in selecting treatment candidates and refining NA stopping rules. AREAS TIMELY FOR DEVELOPING NEW RESEARCH Potential new therapies include viral entry inhibitors, RNA interference technologies (i.e. RNAi) and small molecules that modulate cccDNA transcription, as well as novel immunomodulatory therapies to boost HBV-specific T cell responses. The ultimate goal of new tests and anti-HBV therapies is to reduce the burden and expense of life-long CHB treatment, as 'only diamonds are forever'.
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Affiliation(s)
- Carla S Coffin
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Samuel S Lee
- Liver Unit, Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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92
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Godon O, Evlachev A, Bourgine M, Meritet JF, Martin P, Inchauspe G, Michel ML. Recognition of core-derived epitopes from a novel HBV-targeted immunotherapeutic by T-cells from patients infected by different viral genotypes. Vaccine 2015. [PMID: 26209840 DOI: 10.1016/j.vaccine.2015.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hepatitis B virus (HBV) infects millions of people worldwide and is a leading cause of liver cirrhosis and hepatocellular carcinoma. Current therapies based on nucleos(t)ide analogs or pegylated-interferon-α lead to control of viral replication in most patients but rarely achieve cure. A potential strategy to control chronic hepatitis B is to restore or induce functional anti-HBV T-cell immune responses using HBV-specific immunotherapeutics. However, viral diversity is a challenge to the development of this class of products as HBV genotypes display a sequence diversity of up to 8%. We have developed a novel HBV-targeted immunotherapeutic, TG1050, based on a non-replicative Adenovirus vector encoding a unique and large fusion protein composed of multiple antigenic regions derived from a HBV genotype D sequence. Using peripheral blood mononuclear cells from 23 patients chronically infected by five distinct genotypes (gt A, B, C, D and E) and various sets of peptides encompassing conserved versus divergent regions of HBV core we have measured ability of TG1050 genotype D core-derived peptides to be recognized by T-cells from patients infected by various genotypes. Overall, PBMCs from 78% of genotype B or C- and 100% genotype A or E-infected patients lead to detection of HBV core-specific T-cells recognizing genotype D antigenic domains located both in conserved and variable regions. This proof-of-concept study supports the clinical development of TG1050 in large patient populations independently of infecting genotypes.
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Affiliation(s)
- Ophelie Godon
- Laboratoire de Pathogenèse des virus de l'hépatite B, Département de Virologie, Institut Pasteur, 28, rue du Docteur Roux, Paris Cedex 15 75724, France
| | - Alexei Evlachev
- Transgene SA, Department of Infectious Diseases, Lyon, France
| | - Maryline Bourgine
- Laboratoire de Pathogenèse des virus de l'hépatite B, Département de Virologie, Institut Pasteur, 28, rue du Docteur Roux, Paris Cedex 15 75724, France
| | | | - Perrine Martin
- Transgene SA, Department of Infectious Diseases, Lyon, France
| | | | - Marie-Louise Michel
- Laboratoire de Pathogenèse des virus de l'hépatite B, Département de Virologie, Institut Pasteur, 28, rue du Docteur Roux, Paris Cedex 15 75724, France; INSERM U994, Département de Virologie, Institut Pasteur, Paris, France.
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93
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Gao S, Duan ZP, Coffin CS. Clinical relevance of hepatitis B virus variants. World J Hepatol 2015; 7:1086-1096. [PMID: 26052397 PMCID: PMC4450185 DOI: 10.4254/wjh.v7.i8.1086] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/28/2015] [Accepted: 02/12/2015] [Indexed: 02/06/2023] Open
Abstract
The hepatitis B virus (HBV) is a global public health problem with more than 240 million people chronically infected worldwide, who are at risk for end-stage liver disease and hepatocellular carcinoma. There are an estimated 600000 deaths annually from complications of HBV-related liver disease. Antiviral therapy with nucleos/tide analogs (NA) targeting the HBV polymerase (P) can inhibit disease progression by long-term suppression of HBV replication. However, treatment may fail with first generation NA therapy due to the emergence of drug-resistant mutants, as well as incomplete medication adherence. The HBV replicates via an error-prone reverse transcriptase leading to quasispecies. Due to overlapping open reading frames mutations within the HBV P can cause concomitant changes in the HBV surface gene (S) and vice versa. HBV quasispecies diversity is associated with response to antiviral therapy, disease severity and long-term clinical outcomes. Specific mutants have been associated with antiviral drug resistance, immune escape, liver fibrosis development and tumorgenesis. An understanding of HBV variants and their clinical relevance may be important for monitoring chronic hepatitis B disease progression and treatment response. In this review, we will discuss HBV molecular virology, mechanism of variant development, and their potential clinical impact.
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94
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Song LW, Wang YB, Fang LL, Wu Y, Yang L, Chen JY, Ge SX, Zhang J, Xiong YZ, Deng XM, Min XP, Zhang J, Chen PJ, Yuan Q, Xia NS. Rapid Fluorescent Lateral-Flow Immunoassay for Hepatitis B Virus Genotyping. Anal Chem 2015; 87:5173-80. [DOI: 10.1021/ac504832c] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Liu-Wei Song
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Ying-Bin Wang
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Lin-Lin Fang
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Yong Wu
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Lin Yang
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Jie-Yu Chen
- Xiamen Innovax Biotech Company, Ltd., Xiamen 361022, China
| | - Sheng-Xiang Ge
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Jing Zhang
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - You-Zheng Xiong
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
- School
of Information Science and Engineering, Computer Science Department, Xiamen University, Xiamen 361005, China
| | - Xiu-Mei Deng
- Xiamen Innovax Biotech Company, Ltd., Xiamen 361022, China
| | - Xiao-Ping Min
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
- School
of Information Science and Engineering, Computer Science Department, Xiamen University, Xiamen 361005, China
| | - Jun Zhang
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Pei-Jer Chen
- National
Taiwan University College of Medicine, National Taiwan University, Taipei 10051, Taiwan
| | - Quan Yuan
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
| | - Ning-Shao Xia
- National
Institute of Diagnostics and Vaccine Development in Infectious Diseases,
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics,
School of Life Sciences, Xiamen University, Xiamen 361102, China
- School
of Public Health, Xiamen University, Xiamen 361102, China
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95
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Coffin CS, Osiowy C, Gao S, Nishikawa S, van der Meer F, van Marle G. Hepatitis B virus (HBV) variants fluctuate in paired plasma and peripheral blood mononuclear cells among patient cohorts during different chronic hepatitis B (CHB) disease phases. J Viral Hepat 2015; 22:416-26. [PMID: 25203736 DOI: 10.1111/jvh.12308] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hepatitis B virus is classically considered a hepatotropic virus but also infects peripheral blood mononuclear cells. Chronic hepatitis B has different disease phases modulated by host immunity. We compared HBV variability, drug resistance and immune escape mutations in the overlapping HBV polymerase/surface gene in plasma and peripheral blood mononuclear cells in different disease phases. Plasma and peripheral blood mononuclear cells were isolated from 22 treatment naïve patient cohorts (five inactive, six immune-active, nine HBeAg negative and two immune-tolerant). HBV was genotyped via line probe assay, hepatitis B surface antigen titres were determined by an in-house immunoassay, and HBV DNA was quantified by kinetic PCR. The HBV polymerase/surface region, including full genome in some, was PCR-amplified and cloned, and ~20 clones/sample were sequenced. The sequences were subjected to various mutational and phylogenetic analyses. Clonal sequencing showed that only three of 22 patients had identical HBV genotype profiles in both sites. In immune-active chronic hepatitis B, viral diversity in plasma was higher compared with peripheral blood mononuclear cells. Mutations at residues, in a minority of clones, associated with drug resistance, and/or immune escape were found in both compartments but were more common in plasma. Immune escape mutations were more often observed in the peripheral blood mononuclear cells of immune-active CHB carriers, compared with other disease phases. During all CHB disease phases, differences exist between HBV variants found in peripheral blood mononuclear cells and plasma. Moreover, these data indicate that HBV evolution occurs in a compartment and disease phase-specific fashion.
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Affiliation(s)
- C S Coffin
- Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada; Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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96
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Yuen MF, Ahn SH, Lee KS, Um SH, Cho M, Yoon SK, Lee JW, Park NH, Kweon YO, Sohn JH, Lee J, Kim JA, Lai CL, Han KH. Two-year treatment outcome of chronic hepatitis B infection treated with besifovir vs. entecavir: results from a multicentre study. J Hepatol 2015; 62:526-32. [PMID: 25450709 DOI: 10.1016/j.jhep.2014.10.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS We aimed to compare the viral suppression, safety and rate of drug resistance between besifovir (a new acyclic nucleotide analogue) and entecavir. METHODS Treatment-naïve chronic hepatitis B patients receiving besifovir 90 mg (n=31), 150 mg (n=28) and entecavir 0.5 mg (n=30) were monitored for liver biochemistry, viral serology, HBV DNA levels, development of drug resistance mutations, and adverse events throughout 96 weeks of treatment. RESULTS The mean decline of HBV DNA levels from baseline to week 96 were 5.29, 5.15, and 5.67 logs IU/ml for patients receiving besifovir 90 mg, 150 mg and entecavir 0.5 mg, respectively (p>0.05). Undetectable HBV DNA (<20 IU/ml) were achieved in 80.7%, 78.6%, and 80%; ALT normalization in 90.3%, 78.6%, and 93.3%; and loss of HBeAg in 20%, 21.4%, and 22.2% of patients respectively (all p>0.05). One patient receiving besifovir 90 mg had a virological breakthrough due to drug non-compliance. No patient developed drug resistance mutations. Ten patients had serious adverse events, which were not related to the study medications. The most common side effect related to besifovir was carnitine depletion. Carnitine supplements were prescribed to 83.9% and 100% of patients, who had low carnitine level for any one time during follow-up, receiving besifovir 90 mg and 150 mg respectively. No patient had increased creatinine>0.5 mg/dl from baseline. CONCLUSIONS Besifovir had the same antiviral property as compared to entecavir over 96 weeks of treatment for chronic hepatitis B patients. Besifovir was well tolerated and also had a good clinical safety profile.
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Affiliation(s)
- Man-Fung Yuen
- Department of Medicine, University of Hong Kong, Hong Kong
| | - Sang Hoon Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwan Sik Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soon Ho Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mong Cho
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Seung Kew Yoon
- Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Neung Hwa Park
- Department of Internal Medicine, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young-Oh Kweon
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea
| | - Joo Hyun Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jiyoon Lee
- LG Life Sciences, Ltd., Seoul, Republic of Korea
| | - Jeong-Ae Kim
- LG Life Sciences, Ltd., Seoul, Republic of Korea
| | - Ching-Lung Lai
- Department of Medicine, University of Hong Kong, Hong Kong.
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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97
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Epidemiology of HBV subgenotypes D. Clin Res Hepatol Gastroenterol 2015; 39:28-37. [PMID: 25037178 DOI: 10.1016/j.clinre.2014.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/09/2014] [Accepted: 06/02/2014] [Indexed: 02/04/2023]
Abstract
The natural history of hepatitis B virus infection is not uniform and affected from several factors including, HBV genotype. Genotype D is a widely distributed genotype. Among genotype D, several subgenotypes differentiate epidemiologically and probably clinically. D1 is predominant in Middle East and North Africa, and characterized by early HBeAg seroconversion and low viral load. D2 is seen in Albania, Turkey, Brazil, western India, Lebanon, and Serbia. D3 was reported from Serbia, western India, and Indonesia. It is a predominant subgenotype in injection drug use-related acute HBV infections in Europe and Canada. D4 is relatively rare and reported from Haiti, Russia and Baltic region, Brazil, Kenya, Morocco and Rwanda. Subgenotype D5 seems to be common in Eastern India. D6 has been reported as a rare subgenotype from Indonesia, Kenya, Russia and Baltic region. D7 is the main genotype in Morocco and Tunisia. D8 and D9 are recently described subgenotypes and reported from Niger and India, respectively. Subgenotypes of genotype D may have clinical and/or viral differences. More subgenotype studies are required to conclude on subgenotype and its clinical/viral characteristics.
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98
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Hamada-Tsutsumi S, Iio E, Watanabe T, Murakami S, Isogawa M, Iijima S, Inoue T, Matsunami K, Tajiri K, Ozawa T, Kishi H, Muraguchi A, Joh T, Tanaka Y. Validation of cross-genotype neutralization by hepatitis B virus-specific monoclonal antibodies by in vitro and in vivo infection. PLoS One 2015; 10:e0118062. [PMID: 25693196 PMCID: PMC4333126 DOI: 10.1371/journal.pone.0118062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 01/05/2015] [Indexed: 02/05/2023] Open
Abstract
Vaccines based on hepatitis B virus (HBV) genotype A have been used worldwide for immunoprophylaxis and are thought to prevent infections by non-A HBV strains effectively, whereas, vaccines generated from genotype C have been used in several Asian countries, including Japan and Korea, where HBV genotype C is prevalent. However, acute hepatitis B caused by HBV genotype A infection has been increasing in Japan and little is known about the efficacy of immunization with genotype C-based vaccines against non-C infection. We have isolated human monoclonal antibodies (mAbs) from individuals who were immunized with the genotype C-based vaccine. In this study, the efficacies of these two mAbs, HB0116 and HB0478, were analyzed using in vivo and in vitro models of HBV infection. Intravenous inoculation of HBV genotype C into chimeric mice with human hepatocytes resulted in the establishment of HBV infection after five weeks, whereas preincubation of the inocula with HB0116 or HB0478 protected chimeric mice from genotype C infection completely. Interestingly, both HB0116 and HB0478 were found to block completely genotype A infection. Moreover, infection by a genotype C strain with an immune escape substitution of amino acid 145 in the hepatitis B surface protein was also completely inhibited by incubation with HB0478. Finally, in vitro analysis of dose dependency revealed that the amounts of HB0478 required for complete protection against genotype C and genotype A infection were 5.5 mIU and 55 mIU, respectively. These results suggested that genotype C-based vaccines have ability to induce cross-genotype immunity against HBV infection.
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Affiliation(s)
- Susumu Hamada-Tsutsumi
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Etsuko Iio
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tsunamasa Watanabe
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuko Murakami
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masanori Isogawa
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sayuki Iijima
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takako Inoue
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kayoko Matsunami
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuto Tajiri
- The Third Department of Internal Medicine, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
- The Department of Immunology, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Tatsuhiko Ozawa
- The Department of Immunology, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Hiroyuki Kishi
- The Department of Immunology, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Muraguchi
- The Department of Immunology, Graduate School of Medical and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuhito Tanaka
- Department of Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- * E-mail:
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99
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Bokharaei-Salim F, Keyvani H, Monavari SH, Esghaei M, Fakhim S, Ataei Pirkooh A, Behnava B. Distribution of hepatitis B virus genotypes in azerbaijani patients with chronic hepatitis B infection. HEPATITIS MONTHLY 2014; 14:e25105. [PMID: 25685166 PMCID: PMC4310019 DOI: 10.5812/hepatmon.25105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/18/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis B virus (HBV) has been classified into ten genotypes (A-J) based on genome sequence divergence, which is very important for etiological and clinical investigations. HBV genotypes have distinct geographical distributions worldwide. OBJECTIVES The aim of this study was to investigate the distribution of HBV genotypes among Azerbaijani patients with chronic hepatitis B, came from the Republic of Azerbaijan country to Iran to receive medical care. PATIENTS AND METHODS One hundred and three patients with chronic HBV infection, referred to hospitals related to Iran University of Medical Sciences and Tehran Hepatitis Center from August 2011 to July 2014, were enrolled in this cross sectional study. About 3-milliliter of peripheral blood was taken from each patient. After viral DNA extraction, HBV genotypes were tested using the INNO-LiPA™ HBV kit (Innogenetics, Ghent, Belgium). HBV genotyping was confirmed using sequencing of hepatitis B surface antigen (HBsAg) and polymerase (pol) regions of HBV. RESULTS The mean age of patients was 35.9 ± 11.7 years (19-66). Of 103 patients, 72 (69.9%) were male. In the present study, the predominant HBV genotype was D (93.2%) followed by genotype A (5.8%) and concurrent infection with A and D genotypes (0.97%). CONCLUSIONS The main and frequent HBV genotype among Azerbaijani patients with chronic hepatitis B virus infection was genotype D followed by genotype A.
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Affiliation(s)
- Farah Bokharaei-Salim
- Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Farah Bokharaei Salim, Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2188602205, E-mail:
| | - Hossein Keyvani
- Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Maryam Esghaei
- Department of Virology, Iran University of Medical Sciences, Tehran, IR Iran
| | - Shahin Fakhim
- Department of Civil Engineering, Faculty of Engineering, Payame Noor University, Karaj, IR Iran
| | | | - Bita Behnava
- Middle East Liver Diseases Center, Tehran, IR Iran
- Iran Hepatitis Network, Tehran, IR Iran
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100
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Abstract
Hepatitis B virus infection is a major public health problem worldwide; roughly 30% of the world's population show serological evidence of current or past infection. Hepatitis B virus is a partly double-stranded DNA virus with several serological markers: HBsAg and anti-HBs, HBeAg and anti-HBe, and anti-HBc IgM and IgG. It is transmitted through contact with infected blood and semen. A safe and effective vaccine has been available since 1981, and, although variable, the implementation of universal vaccination in infants has resulted in a sharp decline in prevalence. Hepatitis B virus is not cytopathic; both liver damage and viral control--and therefore clinical outcome--depend on the complex interplay between virus replication and host immune response. Overall, as much as 40% of men and 15% of women with perinatally acquired hepatitis B virus infection will die of liver cirrhosis or hepatocellular carcinoma. In addition to decreasing hepatic inflammation, long-term antiviral treatment can reverse cirrhosis and reduce hepatocellular carcinoma. Development of new therapies that can improve HBsAg clearance and virological cure is warranted.
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Affiliation(s)
- Christian Trépo
- Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France; INSERM U1052, Lyon, France.
| | - Henry L Y Chan
- Department of Medicine and Therapeutics, Institute of Digestive Disease and State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
| | - Anna Lok
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI, USA
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