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Kafeero HM, Ndagire D, Ocama P, Kato CD, Wampande E, Walusansa A, Kajumbula H, Kateete D, Ssenku JE, Sendagire H. Mapping hepatitis B virus genotypes on the African continent from 1997 to 2021: a systematic review with meta-analysis. Sci Rep 2023; 13:5723. [PMID: 37029173 PMCID: PMC10082212 DOI: 10.1038/s41598-023-32865-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/04/2023] [Indexed: 04/09/2023] Open
Abstract
Hepatitis B virus (HBV) has ten genotypes (A-J) and over 40 sub-genotypes based on the divergence of ≥ 8% and 4 to < 8% in the complete genome respectively. These genotypes and sub-genotypes influence the disease prognosis, response to therapy and route of viral transmission. Besides, infection with mixed genotypes and recombinant genotypes has also been reported. This study aimed at mapping the de novo genotypes and correlate them with the immigration trends in order to inform future research on the underlying reasons for the relative distribution of HBV genotypes from a large sample size pooled from many primary studies. Data was extracted from 59 full research articles obtained from Scopus, PubMed, EMBASE, Willy library, African Journal Online (AJOL) and Google Scholar. Studies that investigated the genotypes, sub-genotypes, mixed genotypes and recombinant were included. The Z-test and regression were used for the analysis. The study protocol is registered with PROSPERO under the registration number CRD42022300220. Overall, genotype E had the highest pooled prevalence significantly higher than all the other genotypes (P < 0.001). By region, genotype A posted the highest pooled prevalence in eastern and southern Africa, E in west Africa and D in north Africa (P < 0.0001). Regarding the emerging genotypes B and C on the African continent, genotype B was significantly higher in south Africa than C (P < 0.001). In contrast, genotype C was significantly higher in east Africa than west Africa (P < 0.0001). The A1 and D/E were the most diverse sub-genotypes and genotype mixtures respectively. Finally, we observed a general progressive decrease in the prevalence of predominant genotypes but a progressive increase in the less dominant by region. Historical and recent continental and intercontinental migrations can provide a plausible explanation for the HBV genotype distribution pattern on the African continent.
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Affiliation(s)
- Hussein Mukasa Kafeero
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P. O Box 7062, Kampala, Uganda.
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P. O Box 7689, Kampala, Uganda.
| | - Dorothy Ndagire
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Ponsiano Ocama
- Department of Medicine, College of Health Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Charles Drago Kato
- Department of Biomolecular Resources and Biolab Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Eddie Wampande
- Department of Biomolecular Resources and Biolab Sciences, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Abdul Walusansa
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P. O Box 7689, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - David Kateete
- Department of Molecular Biology and Immunology, College of Health Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Jamilu E Ssenku
- Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
| | - Hakim Sendagire
- Department of Medical Microbiology, College of Health Sciences, Makerere University, P. O Box 7062, Kampala, Uganda
- Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P. O Box 7689, Kampala, Uganda
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Belaiba Z, Ayouni K, Gdoura M, Kammoun Rebai W, Touzi H, Sadraoui A, Hammemi W, Yacoubi L, Abdelati S, Hamzaoui L, Msaddak Azzouz M, Chouikha A, Triki H. Whole genome analysis of hepatitis B virus before and during long-term therapy in chronic infected patients: Molecular characterization, impact on treatment and liver disease progression. Front Microbiol 2022; 13:1020147. [PMID: 36325017 PMCID: PMC9618822 DOI: 10.3389/fmicb.2022.1020147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/15/2022] [Indexed: 07/23/2023] Open
Abstract
Hepatitis B virus (HBV) infection remains a serious public health concern worldwide despite the availability of an efficient vaccine and the major improvements in antiviral treatments. The aim of the present study is to analyze the mutational profile of the HBV whole genome in ETV non-responder chronic HBV patients, in order to investigate antiviral drug resistance, immune escape, and liver disease progression to Liver Cirrhosis (LC) or Hepatocellular Carcinoma (HCC). Blood samples were collected from five chronic hepatitis B patients. For each patient, two plasma samples were collected, before and during the treatment. Whole genome sequencing was performed using Sanger technology. Phylogenetic analysis comparing the studied sequences with reference ones was used for genotyping. The mutational profile was analyzed by comparison with the reference sequence M32138. Genotyping showed that the studied strains belong to subgenotypes D1, D7, and D8. The mutational analysis showed high genetic variability. In the RT region of the polymerase gene, 28 amino acid (aa) mutations were detected. The most significant mutations were the pattern rtL180M + rtS202G + rtM204V, which confer treatment resistance. In the S gene, 35 mutations were detected namely sP120T, sT126S, sG130R, sY134F, sS193L, sI195M, and sL216stop were previously described to lead to vaccine, immunotherapy, and/or diagnosis escape. In the C gene, 34 mutations were found. In particular, cG1764A, cC1766G/T, cT1768A, and cC1773T in the BCP; cG1896A and cG1899A in the precore region and cT12S, cE64D, cA80T, and cP130Q in the core region were associated with disease progression to LC and/or HCC. Other mutations were associated with viral replication increase including cT1753V, cG1764A/T, cC1766G/T, cT1768A, and cC1788G in the BCP as well as cG1896A and cG1899A in the precore region. In the X gene, 30 aa substitutions were detected, of which substitutions xT36D, xP46S, xA47T, xI88F, xA102V, xI127T, xK130M, xV131I, and xF132Y were previously described to lead to LC and/or HCC disease progression. In conclusion, our results show high genetic variability in the long-term treatment of chronic HBV patients causing several effects. This could contribute to guiding national efforts to optimize relevant HBV treatment management in order to achieve the global hepatitis elimination goal by 2030.
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Affiliation(s)
- Zeineb Belaiba
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
- Research Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health,” LR20IPT02, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Kaouther Ayouni
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
- Research Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health,” LR20IPT02, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Mariem Gdoura
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
- Research Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health,” LR20IPT02, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Wafa Kammoun Rebai
- Laboratory of Biomedical Genomics and Oncogenetics (LR16IPT05), Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Henda Touzi
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Amel Sadraoui
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Walid Hammemi
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Lamia Yacoubi
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Salwa Abdelati
- Department of Gastroenterology, Polyclinic of CNSS, Sousse, Tunisia
| | - Lamine Hamzaoui
- Department of Gastroenterology, Hospital of Tahar Maamouri, Nabeul, Tunisia
| | | | - Anissa Chouikha
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
- Research Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health,” LR20IPT02, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Reference Laboratory for Poliomyelitis and Measles in the Eastern Mediterranean Region, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
- Research Laboratory “Virus, Vectors and Hosts: One Health Approach and Technological Innovation for a Better Health,” LR20IPT02, Pasteur Institute of Tunis, University Tunis El Manar (UTM), Tunis, Tunisia
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Disproportionate Distribution of HBV Genotypes A and D and the Recombinant Genotype D/E in the High and Low HBV Endemic Regions of Uganda: A Wake-Up Call for Regional Specific HBV Management. Int J Hepatol 2022; 2022:3688547. [PMID: 35070455 PMCID: PMC8767397 DOI: 10.1155/2022/3688547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/08/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) is the leading cause of liver-related diseases. In Uganda, there is a regional disparity in the HBV burden. Our study was aimed at establishing the circulating genotypes in a low and a high endemic region to give plausible explanations for the differences in regional burden and guide the future management of the disease. METHODS A total of 200 HBsAg-seropositive subjects were recruited into the study by convenience sampling. The HBsAg Rapid Test Strip (Healgen Scientific Limited Liability Company, Houston, TX77047- USA) was used to screen for HBsAg while the Roche machine (Roche, Basel Switzerland/Abbot Technologies (USA)) was used to determine the viral load. The Chemistry Analyzer B120 (Mindray, China) was used for chemistry analysis. For HBV genotyping, total DNA was extracted from whole blood using the QIAamp® DNA extraction kit. Nested PCR amplification was performed using Platinum Taq DNA Polymerase (Invitrogen Corporation, USA) to amplify the 400 bp HBV polymerase gene. Purification of nested PCR products was performed using Purelink PCR product purification kit (Life Technologies, USA). Automated DNA sequencing was performed using BigDye Terminator v3.1 Cycle Sequencing Kit on 3130 Genetic Analyzer (Applied Biosystems, USA). The NCBI HBV genotyping tool (https://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi) was used for determination of genotype for each HBV sequence. Pearson's chi-square, multinomial logistic regression, and Mann-Whitney U tests were used for the analysis. All the analyses were done using SPSS version 26.0 and MedCalc software version 19.1.3 at 95% CI. A p < 0.05 was considered statistically significant. RESULTS Majority of our study subjects were female (64.5%), youth (51.0%), and married (62.0%). Overall, genotype A was the most prevalent (46%). Genotype D and the recombinant genotype D/E were proportionately more distributed in the high endemic (38.2%) and low endemic (36.5%) regions, respectively. Genotype D was significantly more prevalent in the high endemic region and among the elderly (p < 0.05). Genotype D was significantly associated with elevated viral load and direct bilirubin (p < 0.05). The recombinant genotype D/E was significantly associated with elevated viral load (p < 0.05). Similarly, genotype A was significantly associated with elevated AST and GGT, lowered viral load, and normal direct bilirubin levels (p < 0.05). CONCLUSION There is disproportionate distribution of genotypes A and D and the recombinant genotype D/E in the low and high endemic regions of Uganda. This probably could explain the differences in endemicity of HBV in our country signifying the need for regional specific HBV management and control strategies.
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Ajayi BB, Latbone S, Igwegbe IU, Kida IM, Goni BW, Samuel OO, Dawurung JS, Ibrahim HM, Danue BA, Abdullahi IN, Oderinde BS. Serological detection of hepatitis B and D virus co-infection among patients attending a tertiary health facility at Maiduguri, Nigeria. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00036-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatitis D virus (HDV) is highly pathogenic, and clinical studies revealed that HDV infection aggravates the natural history of the underlying hepatitis B virus (HBV) infection by progression to cirrhosis that leads to early decompensation of liver function compared with HBV mono-infection. To determine the seroprevalence of HDV among HBsAg-seropositive patients and associated biochemical profiles at Maiduguri, Nigeria, a hospital-based cross-sectional study on 180 sera of patients positive for HBsAg by ELISA were evaluated for anti-HDV, hepatitis B envelop antigen, anti-HBs antibodies and liver enzyme profiles.
Results
HDV seroprevalence of 3.3% among 180 HBsAg-positive patients. Relatively higher seroprevalence of HDV was observed in males (4.3%) than in females (2.3%). The highest infection rate (20%) was obtained in patients ≥ 56 years. However, no significant association between positive anti-HDV seroprevalence and gender (p > 0.05). Of the 6 (3.3%) anti-HDV-positive patients, only 1 (16.7%) was positive for HBeAg while all were negative for anti-HBs antibodies. The mean level of liver enzyme level of AST and ALT of the anti-HDV-positive patients significantly differ from that of HBsAg mono-infected patients (p ˂ 0.05). However, no significant difference (p < 0.05) between the mean levels of liver enzymes of ALP in anti-HDV-positive and HBsAg mono-infected patients (p ˃ 0.05) was found.
Conclusion
This study revealed a relatively low presence of HDV in HBsAg-positive patients. Furthermore, HDV-HBV co-infected patients had somewhat worse liver enzyme upregulation. This underscores the need for rapid HDV testing and treatment in HBV-infected patients.
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A Systematic Review of the Current Hepatitis B Viral Infection and Hepatocellular Carcinoma Situation in Mediterranean Countries. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7027169. [PMID: 32626758 PMCID: PMC7305551 DOI: 10.1155/2020/7027169] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/04/2020] [Accepted: 02/22/2020] [Indexed: 12/13/2022]
Abstract
Viral hepatitis B is a global public health problem affecting nearly two billion subjects; 3.3% of whom are from the WHO (World Health Organization) Eastern Mediterranean Region (EMRO). It induces both acute and chronic hepatic disorders with subsequent liver cirrhosis and hepatocellular carcinoma (HCC) in a considerable percentage of patients based on the age of exposure. In this review, hepatitis B virus (HBV) and HCC prevalence, distribution and prevalence of different genotypes, and male/female infection frequencies in relation to the vaccination status in the Mediterranean countries were reported. Study Design. This systematic review describes the prevalence of hepatitis B infection, genotype distribution of hepatitis B virus, and prevalence and incidence of hepatocellular carcinoma in Mediterranean countries belonging to three different continents: Southern Europe (Spain, France, Italy, Croatia, and Greece), North Africa (Morocco, Algeria, Tunisia, Libya, and Egypt), and the Near East region (Syria, Lebanon, Turkey, Israel, and Palestine). We tried to collect new data from electronic databases: PubMed, ScienceDirect, ResearchGate, Google Scholar, and public health reports between 1980 and 2019. For each publication, we recorded reference, publication year, study characteristics (date, locations, sample size, and study population), and participant characteristics (population group, year, age, and sex). No language limitation was imposed, and articles or reports from non-peer-reviewed sources were not considered for this analysis. The main keywords were HBV prevalence, hepatitis B infection, HBV genotype, and HCC. Inclusion and Exclusion Criteria. Healthy population-based studies included the following sample populations: (i) voluntary blood donors, (ii) pregnant women, (iii) community studies, (iv) hemodialysis patients, (v) hospitalized patients, (vi) healthcare workers, (vii) sex workers, (viii) drug abusers, and (ix) prisoners. We excluded studies from the following special groups who were assumed to be at a special high risk: patients from sexually transmitted disease clinics and thalassemia clinics and professional or paid blood donors.
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Kheirabad AK, Farshidfar G, Nasrollaheian S, Gouklani H. Prevalence and Characteristics of Precore Mutation in Iran and Its Correlation with Genotypes of Hepatitis B. Electron Physician 2017; 9:4114-4123. [PMID: 28607644 PMCID: PMC5459281 DOI: 10.19082/4114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 11/03/2016] [Indexed: 01/05/2023] Open
Abstract
Introduction Mutation of the HBV precore gene prevents the production of HBeAg, which is an important target for immune responses. Distribution of this mutation varies along with frequency of HBV genotypes in accordance with geographic and ethnic variations. The general objective of this study was to evaluate the prevalence and characteristics of precore mutation in Iran and its correlation with genotypes of hepatitis B. Methods In this cross-sectional study, viral DNA of 182 Iranian hepatitis B surface antigen positive patients who were admitted to Bandar Abbas Blood Transfusion Organization in 2012 and 2013 was retrieved from their serum samples. HBeAg, anti-HBe, and anti-HBc IgM diagnostic tests were performed using ELISA kits. Precore and Pre-S regions were amplified using specific primers and PCR thereafter to determine the genotypes; precore mutation, PCR, and restriction fragment length polymorphism (RFLP) methods also were applied. SPSS version 12 was used for data analysis by Mann–Whitney U test, Fisher’s exact probability test, and t-test. Results A total of 62 patients (34.1%) had precore mutation (A1896G), and genotype D was the predominant genotype in these patients, which was followed by an unknown genotype that was suspected for genotype B. Interestingly, the relationships between precore mutation and HBeAg (p=0.037) and genotype D (p=0.005) were significant; however, no correlation was observed between this mutation and acute or chronic hepatitis and sex of patients. Conclusion This study found high prevalence of precore mutations in southern Iran, which was significantly associated with HBeAg and genotype D.
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Affiliation(s)
- Ali Kargar Kheirabad
- Ph.D., Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Farshidfar
- Ph.D., Department of Biochemistry, School of Medicine, Hormozgan University of Medical Sciences, Iran
| | | | - Hamed Gouklani
- Ph.D., Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Widespread geographical disparities in chronic hepatitis B virus infection in Algeria. Arch Virol 2017; 162:1641-1648. [PMID: 28236070 DOI: 10.1007/s00705-017-3284-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 02/07/2017] [Indexed: 12/11/2022]
Abstract
Algeria is the largest country of Africa, with a population of 40 million inhabitants living in disparate environments from the Sahara to the large cities of the Mediterranean coast. The molecular epidemiology of hepatitis B virus (HBV) variants has been partially described, but variations in the seroprevalence of HBV surface antigen (HBsAg) throughout the Algerian territories are still poorly described. We analyzed demographic features of new cases of chronic infection collected in 41 administrative regions (covering 92% of the population) in 2013. The mean age of the 1876 HBsAg(+) patients was 36.8 ± 14.2 years, with a slight excess of males (54%). The seroprevalence of HBV early antigen (HBeAg) was 9.3%, and the mean virus load was 3.2 ± 1.8 log IU/ml. A subset of 15.2% of patients was already cirrhotic at disease discovery. An important heterogeneity was observed throughout the country, with nine regions displaying a significant excess of cases. These regions formed four distinct foci located in distant parts of the country: Adrar-Bechar (southwest), El-Oued-Tebessa (east), M'Sila-Sétif (north central) and Oran-Aïn Temouchent (northwest). An excess of cases was found as well in the national capital Algiers. Patients from southern regions with an excess of cases (Bechar, Adrar, El Oued) were significantly younger (32.0 ± 10.7 years), as were patients from the regions of Bejaia and Bouira (32.1 ± 10.6). The southwestern regions were also marked by a significant imbalance of the sex ratio (58 vs 39% of female cases, P = 4.5 E-5). The highest HBeAg seroprevalence was observed in Setif (26.4 vs. 7.6%, OR = 4.3, 95% CI 2.6-6.5, P = 1.1 × 10-11) in accordance with the higher virus loads observed in the patients (3.9 ± 2.3 vs. 3.1 ± 1.6, P = 0.0002). In conclusion, we observed heterogeneity in HBsAg seroprevalence, demographic traits, and disease evolution in Algeria. Further studies are now warranted to shed light on these differences, which are presumably due to variability in transmission routes or in the infectivity of viral isolates.
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Lo Presti A, Andriamandimby SF, Lai A, Angeletti S, Cella E, Mottini G, Guarino MPL, Balotta C, Galli M, Heraud JM, Zehender G, Ciccozzi M. Origin and evolutionary dynamics of Hepatitis B virus (HBV) genotype E in Madagascar. Pathog Glob Health 2017; 111:23-30. [PMID: 28081689 DOI: 10.1080/20477724.2016.1278103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Africa is one of the endemic regions of HBV infection. In particular, genotype E is highly endemic in most of sub-Saharan Africa such as West African countries where it represents more than 90% of total infections. Madagascar, which is classified as a high endemic area for HBV and where the most prevalent genotype is E, might play a relevant role in the dispersion of this genotype due to its crucial position in the Indian Ocean. The aim of this study was to investigate the origin, population dynamics, and circulation of HBV-E genotype in Madagascar through high-resolution phylogenetic and phylodynamic approaches. The phylogenetic tree indicated that Malagasy isolates were intermixed and closely related with sequences mostly from West African countries. The Bayesian tree highlighted three statistically supported clusters of Malagasy strains which dated back to the years 1981 (95% HPD: 1971-1992), 1986 (95% HPD: 1974-1996), and 1989 (95% HPD: 1974-2001). Population dynamics analysis showed an exponential increase in the number of HBV-E infections approximately from the year 1975 until 2000s. The migration analysis was also performed and a dynamic pattern of gene flow was identified. In conclusion, this study confirms previous observation of HBV-E circulation in Africa and expands these findings at Madagascar demonstrating its recent introduction, and highlighting the role of the African countries in the spread of HBV-E genotype. Further studies on molecular epidemiology of HBV genotype E are needed to clarify the evolutionary history of this genotype.
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Affiliation(s)
- Alessandra Lo Presti
- a Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases , Istituto Superiore di Sanità , Rome , Italy
| | | | - Alessia Lai
- c Department of Biomedical and Clinical Sciences "Luigi Sacco", Infectious Diseases and Immunopathology Section, 'L. Sacco' Hospital , University of Milan , Milan , Italy
| | - Silvia Angeletti
- d Clinical Pathology and Microbiology Laboratory , University Hospital Campus Bio-Medico of Rome , Rome , Italy
| | - Eleonora Cella
- a Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases , Istituto Superiore di Sanità , Rome , Italy.,e Public Health and Infectious Diseases , Sapienza University , Rome , Italy
| | | | | | - Claudia Balotta
- c Department of Biomedical and Clinical Sciences "Luigi Sacco", Infectious Diseases and Immunopathology Section, 'L. Sacco' Hospital , University of Milan , Milan , Italy
| | - Massimo Galli
- c Department of Biomedical and Clinical Sciences "Luigi Sacco", Infectious Diseases and Immunopathology Section, 'L. Sacco' Hospital , University of Milan , Milan , Italy
| | - Jean-Michel Heraud
- b Virology Unit , Institut Pasteur of Madagascar , Antananarivo , Madagascar
| | - Gianguglielmo Zehender
- c Department of Biomedical and Clinical Sciences "Luigi Sacco", Infectious Diseases and Immunopathology Section, 'L. Sacco' Hospital , University of Milan , Milan , Italy
| | - Massimo Ciccozzi
- a Epidemiology Unit, Department of Infectious, Parasitic and Immune-Mediated Diseases , Istituto Superiore di Sanità , Rome , Italy.,f University Hospital Campus Bio-Medico , Rome , Italy
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Hussein WM, Anwar WA, Attaleb M, Mazini L, Försti A, Trimbitas RD, Khyatti M. A review of the infection-associated cancers in North African countries. Infect Agent Cancer 2016; 11:35. [PMID: 27512409 PMCID: PMC4979152 DOI: 10.1186/s13027-016-0083-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/09/2016] [Indexed: 02/08/2023] Open
Abstract
Cancer is typically classified as a leading non-communicable disease; however, infectious agents, such as Helicobacter pylori (H. pylori), hepatitis B virus (HBV), hepatitis C virus (HCV) and human papilloma virus (HPV), contribute significantly to the pathogenesis of various cancers. Less developed countries, including countries of the North African (NA) region, endure the highest burden of infection-related cancers. The five most common infection-associated cancers in NA in order of incidence are bladder cancer, cervical cancer, liver cancer, stomach cancer, and nasopharyngeal carcinoma. This review aims to outline the epidemiologic pattern of infection-associated cancers in five NA countries (namely: Morocco, Algeria, Tunisia, Libya and Egypt) highlighting the similarities and differences across the region. The present study employed an initial literature review of peer-reviewed articles selected from PubMed, ScienceDirect and World Health Organization (WHO) databases based on key word searches without restriction on publication dates. Original research articles and reports written in French, as well as data from institutional reports and regional meeting abstracts were also included in this extensive review. Egypt, Libya, Tunisia, Algeria and Morocco were selected to be the focus of this review.
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Affiliation(s)
- Wafaa Mohamed Hussein
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain ShamsUniversity, Cairo, Egypt
| | - Wagida A Anwar
- Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain ShamsUniversity, Cairo, Egypt
| | - Mohammed Attaleb
- Biology and Medical Research Unit, National Center of Energy, Sciences and Nuclear Technics, Rabat, Morocco
| | - Loubna Mazini
- Laboratory of Onco-virology, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Asta Försti
- Department of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany ; Center for Primary Health Care Research, Clinical Research Center, Lund University, Malmö, Sweden
| | | | - Meriem Khyatti
- Laboratory of Onco-virology, Institut Pasteur du Maroc, Casablanca, Morocco
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Limited Genetic Diversity of Hepatitis B Virus in the General Population of the Offin River Valley in Ghana. PLoS One 2016; 11:e0156864. [PMID: 27271290 PMCID: PMC4894622 DOI: 10.1371/journal.pone.0156864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/16/2016] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus (HBV) infections account for approximately 780,000 deaths per year, most of which occur in the developing world. Co-infection with HBV and hepatitis delta virus (HDV) may lead to the most severe form of viral hepatitis. In Ghana, knowledge on the prevalence of HBV and HDV in the general population is scanty and the few genetic analyses of the prevailing HBV genotypes are dating back more than a decade. In the present study, 1,323 serum samples from individuals living in a rural area (Offin river valley) of Ghana were analyzed for the presence of the hepatitis B surface antigen (HBsAg). Positive sera were subsequently tested for the presence of anti-HDV antibodies. A total of 107 (8%) sera were HBsAg positive with an 8.4% prevalence of anti-HDV antibodies among the HBsAg positives. Phylogenetic analysis based on HBV pre-S/S sequences, attributed all 52 typable samples to genotype E. All belonged to serotype ayw4. While 19 sequences clustered with those from a number of African countries, the other 33 formed a separate cluster distinguished by an intergroup mean distance of 1.5% from the pan-African HBV/E cluster. Successful implementation of HBV vaccination in the region was reflected by the low HBsAg carrier rate of 1.8% among children ≤11 years.
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Abu Zeid WM, Ramadan DI, Shemis MA. Prevalence of mutations within major hydrophilic region of hepatitis B virus and their correlation with genotypes among chronically infected patients in Egypt. Arab J Gastroenterol 2016; 17:34-40. [PMID: 27055927 DOI: 10.1016/j.ajg.2016.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 03/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND STUDY AIMS Mutations within the major hydrophilic region (MHR) of the hepatitis B surface antigen (HBsAg) have been reported in relation to viral persistence by evasion from vaccine and immunotherapy, severity of liver disease and lack of detection by commercial kits. The aim of this study was to elucidate the circulation of hepatitis B virus (HBV) genotypes, subgenotypes and serotypes in Egypt, with recognition of the pattern and prevalence of MHR mutations possibly occurring during the course of the disease. PATIENTS AND METHODS Eighty-eight samples from patients with chronic HBV infection were included in the study. The surface protein-encoding gene (S gene) in the HBV genome was subjected to amplification and partial sequencing. RESULTS Based on phylogenetic analysis, only genotype D was found circulating among patients. The majority of isolates belonged to subgenotype D3 (86.3%), followed by D7 (8%), then D5 (3.4%) and lastly D1 (2.3%). Two subtypes were identified: ayw2 (97%) and ayw3 (2%). The 'w' sub-determinant was not defined in one isolate (1%). A significant proportion of patients (13/88, 14.8%) exhibited mutations in the MHR, 10 of whom harboured mutations in the 'a' determinant region and three outside. The first loop comprised four patients with three mutations (P127S, P127T and Y134F). The second loop contained six patients, all with one mutation, S143L, which was most frequently encountered in this study (6.8%). CONCLUSIONS We conclude that genotype D, subgenotype D3 and HBsAg subtype ayw2 are the most common types circulating in Egypt, which account for 100%, 86.3% and 97% of the population, respectively, with a moderate degree of MHR mutations.
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Affiliation(s)
| | - Dalia I Ramadan
- Department of Clinical and Chemical Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Mohamed A Shemis
- Department of Biochemistry & Molecular Biology, Theodor Bilharz Research Institute, Giza, Egypt
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Brah S, Moussa S, Inoua A, Alhousseini DM, Daou M, Madougou B, Romera MH, Hamadou A, Adehossi E, Parola P, Colson P. Molecular characterization of hepatitis B virus from chronically-infected patients in Niamey, Niger. Int J Infect Dis 2016; 45:18-23. [PMID: 26899956 DOI: 10.1016/j.ijid.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES In Niger, 65% of hepatocarcinoma and 75% of cirrhosis cases were due to hepatitis B virus (HBV). We studied the genotypic characteristics of HBsAg in chronically HBV-infected patients in Niamey. METHODS We studied prospectively HBV genotypic patterns among hospitalized patients with HBV infection in the National Hospital of Niamey, Niger. Patients were screened for hepatitis B surface antigen (HBsAg) and HBV genotyping was performed on the HBsAg-positive patients. RESULTS In this study, we have confirmed the predominance of the HBV genotype E (HBV-E) in Niger and have identified 2 recombinant forms including HBV-E/D and HBV-A3/E reported previously among blood donors in Niger and Ghana, respectively. Amino acid substitutions found in HBV sequences obtained here included P120T, S143L, G145A and A194T. These substitutions were characterized as being associated with modified antigenicity and, notably, with impaired serological detection of HBsAg, while the A194T variant was found to have a controversial role in reduced susceptibility to tenofovir. CONCLUSIONS We have identified two recombinant HBV forms and rare genotypic patterns in Niger that may affect hepatitis B surface antigen antigenicity, and improve current knowledge of epidemiological, clinical and virological patterns of hepatitis B in this country.
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Affiliation(s)
- Souleymane Brah
- IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses, Centre Hospitalo-Universitaire Nord, Assistance Publique - Hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20; Service de médecine interne, Hôpital National de Niamey, BP 238 - Niger
| | - Sahada Moussa
- Service de maladies infectieuses, Hôpital National de Niamey, BP 238 - Niger
| | - Achirou Inoua
- Service de médecine interne, Hôpital National de Niamey, BP 238 - Niger
| | | | - Mamane Daou
- Service de médecine interne, Hôpital National de Niamey, BP 238 - Niger
| | - Boubacar Madougou
- Service de gastro entérologie, Hôpital National de Niamey, BP 238 - Niger
| | - Marie-Hélène Romera
- IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, 264 rue Saint-Pierre 13385, Marseille CEDEX 05, France
| | - Adamou Hamadou
- Service de médecine interne, Hôpital National de Niamey, BP 238 - Niger
| | - Eric Adehossi
- Service de médecine interne, Hôpital National de Niamey, BP 238 - Niger
| | - Philippe Parola
- IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Service de Maladies Infectieuses, Centre Hospitalo-Universitaire Nord, Assistance Publique - Hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille cedex 20; Aix-Marseille University, URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, 27 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France
| | - Philippe Colson
- Aix-Marseille University, URMITE UM 63 CNRS 7278 IRD 198 INSERM U1905, 27 boulevard Jean Moulin, 13385 Marseille CEDEX 05, France; IHU Méditerranée Infection, Pôle des Maladies Infectieuses et Tropicales Clinique et Biologique, Fédération de Bactériologie-Hygiène-Virologie, Centre Hospitalo-Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, 264 rue Saint-Pierre 13385, Marseille CEDEX 05, France.
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Mhalla S, Kadri Y, Alibi S, Letaief A, Boukadida J, Hannachi N. Hepatitis D Virus Infection Among Hepatitis B Surface Antigen Carriers and in "Isolated anti-HBc" Antibodies Profile in Central Tunisia. HEPATITIS MONTHLY 2016; 16:e32354. [PMID: 27110257 PMCID: PMC4834381 DOI: 10.5812/hepatmon.32354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/31/2015] [Accepted: 12/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis D Virus (HDV) causes accelerated liver diseases in patients with Hepatitis B Virus (HBV) infection. There is lack of data about its prevalence, related risk factors and interaction with HBV carriers in our country. OBJECTIVES The aim of this study was to estimate the prevalence of hepatitis delta and associated risk factors among Hepatitis B surface antigen (HBsAg) and "isolated anti-HBc" profile carriers in central Tunisia. PATIENTS AND METHODS In this cross-sectional study, 540 patients with positive HBsAg and 109 "isolated anti-HBc" profile receiving care in a teaching hospital were tested for the presence of HDV serum-markers using commercially available enzyme immunoassay kit. HBV-DNA was detected by nested PCR in "isolated anti-HBc" profile group. RESULTS Prevalence of HDV was 8.1% in HBsAg carriers group, but it was significantly higher in active than inactive hepatitis (30.2% and 4.5%, respectively, OR = 9, 95% CI: [4.48-18.58]). There was no significant association between studied risk factors and HDV infection. In the "isolated anti-HBc" profile group, prevalence of HDV was 4.6% and HBV-DNA had negative result in all patients with positive results for HDV. CONCLUSIONS Although HDV had low prevalence in our area, it is vital to plan preventive strategies for HDV spread as well as HBV prevention. It is particularly important to suspect HDV infection in active HBV carriers to manage a particularly severe dual infection. HDV infection should be suspected even in negative HBsAg patients having "isolated anti-HBc" profile.
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Affiliation(s)
- Salma Mhalla
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
- Corresponding Author: Salma Mhalla, Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia. E-mail:
| | - Yosr Kadri
- Department of Microbiology, Fattouma Bourguiba Teaching Hospital, University of Monastir, Monastir, Tunisia
| | - Sana Alibi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Amel Letaief
- Department of Infectious Disease, F. Hached Teaching Hospital, University of Sousse, Sousse, Tunisia
| | - Jalel Boukadida
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
| | - Naila Hannachi
- Laboratory of Microbiology and Immunology, F. Hached Teaching Hospital, (UR12SP34) University of Sousse, Sousse, Tunisia
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Yacoubi L, Brichler S, Mansour W, Le Gal F, Hammami W, Sadraoui A, Ben Mami N, Msaddek A, Cheikh I, Triki H, Gordien E. Molecular epidemiology of hepatitis B and Delta virus strains that spread in the Mediterranean North East Coast of Tunisia. J Clin Virol 2015; 72:126-32. [PMID: 26513762 DOI: 10.1016/j.jcv.2015.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/28/2015] [Accepted: 10/04/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tunisia is classified as an area of middle endemic for hepatitis B virus (HBV) infection, however little is known about hepatitis Delta virus (HDV) infection. OBJECTIVES This study aimed to address the prevalence of HDV infection, to identify possible risks factors, and to analyze the genetic diversity of HDV strains that are spreading in Tunisia. STUDY DESIGN A retrospective large-scale study including 1615 HBsAg positive patients, native of the North East coast of Tunisia, recruited from Gastroenterology departments, was conducted. Demographic, epidemiological, ethnical, clinical and biological data were recorded. HBV and HDV serological analyses and DNA and RNA viral load quantification were performed. Genotyping of HBV and HDV strains was performed using nucleotide sequencing followed by phylogenetic analyses. RESULTS The study population included 819 (50.7%) men and 796 (49.3%) women; aged 12-90 years (mean age 41±13 years). A very low prevalence of HDV infection, 2% was observed. No risk factor, except a history of hospitalization for surgery was found. All HDV strains belonged to genotype 1, with a wide distribution within the HDV-1 group. They all share the African amino acid marker, a serine at position 202 of the large Delta protein. HBV genotypes were distributed as follows: HBV/D1 (56.8%), HBV/D7 (40.9%), and HBV/A2 (2.3%). CONCLUSION Tunisia is a low endemic region for HDV infection, due to an efficient policy of HBV infection control. HDV-1 is the sole genotype found, with a high diversity within this group. Further studies are ongoing in order to better characterize and manage the HBV/HDV-infected patients according to the genetic variability of the viral strains.
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Affiliation(s)
- Lamia Yacoubi
- Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia; Carthage University, Tunis, Tunisia
| | - Ségolène Brichler
- Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre National de Référence des Hépatites B, C et Delta, UFR Santé Médecine Biologie Humaine, Université Paris 13, Bobigny, France
| | - Wael Mansour
- Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre National de Référence des Hépatites B, C et Delta, UFR Santé Médecine Biologie Humaine, Université Paris 13, Bobigny, France
| | - Frédéric Le Gal
- Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre National de Référence des Hépatites B, C et Delta, UFR Santé Médecine Biologie Humaine, Université Paris 13, Bobigny, France
| | - Walid Hammami
- Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia
| | - Amel Sadraoui
- Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia
| | - Nabil Ben Mami
- Department of Gastroenterology B, La Rabta Hospital, Tunisia; Tunis El Manar University, Tunis, Tunisia
| | - Azouz Msaddek
- Department of Gastroenterology, Tahar Maamouri Hospital, Nabeul, Tunisia; Tunis El Manar University, Tunis, Tunisia
| | - Imed Cheikh
- Department of Gastroenterology, Habib Bougatfa Hospital, Bizerte, Tunisia; Tunis El Manar University, Tunis, Tunisia
| | - Henda Triki
- Laboratoire de Virologie Clinique, Institut Pasteur de Tunis, Tunisia; Tunis El Manar University, Tunis, Tunisia.
| | - Emmanuel Gordien
- Laboratoire de Bactériologie, Virologie, Hygiène, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre National de Référence des Hépatites B, C et Delta, UFR Santé Médecine Biologie Humaine, Université Paris 13, Bobigny, France.
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Al Baqlani SA, Sy BT, Ratsch BA, Al Naamani K, Al Awaidy S, Busaidy SA, Pauli G, Bock CT. Molecular epidemiology and genotyping of hepatitis B virus of HBsAg-positive patients in Oman. PLoS One 2014; 9:e97759. [PMID: 24835494 PMCID: PMC4023993 DOI: 10.1371/journal.pone.0097759] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/22/2014] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis B virus (HBV) infection is a major global health burden with distinct geographic public health significance. Oman is a country with intermediate HBV carrier prevalence; however, little is known about the incidence of HBV variants in circulation. We investigated the HBV genotype distribution, the occurrence of antiviral resistance, and HBV surface antigen (HBsAg) escape mutations in HBsAg-positive patients in Oman. Methods Serum samples were collected from 179 chronically HBV-infected patients enrolled in various gastroenterology clinics in Oman. HBV genotypes were determined by sequencing and phylogenetic analysis. Mutations in the HBV polymerase and the HBsAg gene were characterized by mutational analysis. Results HBV genotypes D (130/170; 76.47%) and A (32/170; 18.28%) are predominant in Oman. The HBV genotypes C and E were less frequent (each 1.18%), while the HBV genotypes B, G, F, and H were not detected. Four patients revealed HBV genotype mixtures (HBV-A/D and D/C). The analyses of vaccine escape mutations yield that 148/170 (87.06%) HBV sequences were wild type. 22/170 (12.94%) HBV sequences showed mutations in the “a” determinant of the HBsAg domain. Two patients showed the described HBV vaccine escape mutation sP120T. 8/146 (5.48%) HBV isolates harbored mutations in the HBV polymerase known to confer resistance against antiviral therapy. Especially the lamivudine resistance mutations rtL180M/rtM204V and rtM204I were detected. Conclusion This study shows the distribution of HBV genotypes, therapy resistance, and vaccine escape mutations in HBV-infected patients in Oman. Our findings will have a major impact on therapy management and diagnostics of chronic HBV infections in Oman to control HBV infection in this intermediate HBV-endemic country.
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Affiliation(s)
| | - Bui Tien Sy
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- Vietnam Military Medical University, Ha Dong, Ha Noi, Viet Nam
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Boris A. Ratsch
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | | | - Salah Al Awaidy
- Office of the Undersecretary for Health Affairs – Ministry of Health, Muscat, Oman
| | | | - Georg Pauli
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - C.-Thomas Bock
- Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- * E-mail:
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Bajrai LH, Kumosani T, El-Kafrawy S, El-Daly M, Hindawi S, Ashshi A, Azhar EI. Distribution of HBV genotypes from two blood transfusion centers in western Saudi Arabia. Future Virol 2014. [DOI: 10.2217/fvl.14.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: To determine the distribution of HBV genotypes among HBsAg-positive blood donors in Makkah and Jeddah. Materials & methods: A total of 158 volunteered HBsAg-positive male blood donors donated blood samples at two transfusion centers in western Saudi Arabia. RFLP digestion was performed on 83 PCR products of the S gene. A subset of 77 positive samples were sequenced and aligned with reference Genbank sequences. Results: RFLP showed the following genotype distribution: 71 (85.6%) D; two (2.4%) E; one (1.2%) A; one (1.2%) B; one (1.2%) C; five (6.0%) untypable; one (1.2%) mixed genotypes D+A; and one (1.2%) mixed genotype D+C. Seventy-seven samples were genotyped by sequencing as follows: 73 (94.8%) D, three (3.9%) E; and one (1.3%) A. The study showed that there is concordance in the results of RFLP and sequencing in 67 samples and discrepancy in ten samples: genotypes B, genotype C, one of genotype E and dual genotypes by RFLP could only been detected as genotype D by sequencing. Sequencing showed the RFLP untypable samples as genotypes D and E. Conclusion: HBV type D is the most prevalent genotype in western Saudi Arabia. RFLP is a reliable tool for predicting genotype D in Saudi population.
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Affiliation(s)
- Leena H Bajrai
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Taha Kumosani
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Experimental Biochemistry Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sherif El-Kafrawy
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mai El-Daly
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salwa Hindawi
- Blood Transfusion Services, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Ashshi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Ouneissa R, Bahri O, Ben Yahia A, Touzi H, Azouz MM, Ben Mami N, Triki H. Evaluation of PCR-RFLP in the Pre-S Region as Molecular Method for Hepatitis B Virus Genotyping. HEPATITIS MONTHLY 2013; 13:e11781. [PMID: 24348634 PMCID: PMC3842526 DOI: 10.5812/hepatmon.11781] [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: 04/29/2013] [Revised: 08/01/2013] [Accepted: 10/06/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a public health problem in developing countries. HBV genotypes play major role in the evolution of infection since they were involved in different clinical presentations and response to treatment. OBJECTIVES This study was conducted to evaluate the efficiency of restriction fragment length polymorphism (RFLP) analysis for HBV genotyping. PATIENTS AND METHODS We investigated 98 samples collected from patients chronically infected with HBV. HBV genotypes were determined by analysis of patterns obtained after amplification in Pre-S region and digestion of the amplicon by two endonucleases AvaII and DpnII. Obtained results were confirmed by partial sequencing in the same region. RESULTS Two different HBV genotypes were detected in this study, Genotype D (in 95. 9%) and Genotype A (in 4.1%). Seventy-four samples (75.5%) were successfully genotyped with RFLP analysis and all classified as genotype D. The remaining 24 samples (24.5%) which were un-genotyped by RFLP analysis, were classified by partial sequencing of the pre-S region as HBV genotype D (20 samples, 20.4%) and genotype A (4 samples, 4.1%). Atypical profiles were significantly associated with advanced liver disease (P = 0.001) as well as older age (P < 0.05). CONCLUSIONS Several previous studies used PCR-RFLP to genotype HBV; however, we showed the high risk to obtain atypical profiles, especially in advanced stages of chronic infection, with as results difficulties to genotype the virus. These profiles resulted from the accumulation of mutations during natural course of infection resulting in a modification in restriction sites for enzymes. So, we recommended completing the investigation by partial sequencing to confirm obtained results.
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Affiliation(s)
- Rim Ouneissa
- Laboratory of Clinical Virology, Institute Pasteur de Tunis, Tunis, Tunisia
| | - Olfa Bahri
- Laboratory of Clinical Virology, Institute Pasteur de Tunis, Tunis, Tunisia
- Corresponding author: Olfa Bahri, Laboratory of Clinical Virology, Institute Pasteur de Tunis, Tunis, BP 1002, Tunisia. Tel: +216-98334999, Fax: +216-71791833, E-mail:
| | - Ahlem Ben Yahia
- Laboratory of Clinical Virology, Institute Pasteur de Tunis, Tunis, Tunisia
| | - Henda Touzi
- Laboratory of Clinical Virology, Institute Pasteur de Tunis, Tunis, Tunisia
| | | | - Nabyl Ben Mami
- Department of Gastroenterology, Hospital La Rabta, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, Institute Pasteur de Tunis, Tunis, Tunisia
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Ezzikouri S, Pineau P, Benjelloun S. Hepatitis B virus in the Maghreb region: from epidemiology to prospective research. Liver Int 2013; 33:811-9. [PMID: 23530901 DOI: 10.1111/liv.12135] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/28/2013] [Indexed: 12/21/2022]
Abstract
Hepatitis B virus (HBV) represents an important health problem in the Maghreb countries, Algeria, Libya, Mauritania, Morocco and Tunisia, but no detailed synthesis of its epidemiology is available. In this review, we systematically searched for data about HBV in the Maghreb in peer-reviewed databases and included in our analysis works written in English and French, as well as institutional reports and regional conference meeting abstracts. We estimated national and regional prevalence of chronic HBV infection. In addition, we discuss molecular features of the viral strains circulating in the region. Data analysis suggests that in the Maghreb region HBs antigen carriage concerns 1.8-4.9% of the population for an estimated number of 2.7 million persons. Genotype D, subtype D7, is predominant and mutations in the precore region of HBV genome are highly prevalent. This epidemiological situation requires obviously widespread active interventions for prevention and control. In addition, anti-hepatitis B vaccination programme should be applied with the utmost discipline in the five countries considered in this present review. This systematic review will, hopefully, increase knowledge at disposal of Public Health authorities, enabling better resource allocation and healthcare delivery. The present synthesis intends to stimulate policies aiming at preventing the spread of HBV, keeping in mind that eradication of the virus from Maghrebi populations should be the ultimate objective of Public Health authorities.
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Affiliation(s)
- Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Pasteur Institute of Morocco, Casablanca, Morocco.
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Mohamadkhani A, Bastani F, Sotoudeh M, Sayehmiri K, Shahnazari P, Montazeri G, Poustchi H. Influence of B cells in liver fibrosis associated with hepatitis B virus harboring basal core promoter mutations. J Med Virol 2013; 84:1889-96. [PMID: 23080492 DOI: 10.1002/jmv.23410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The development of the liver disease in chronic hepatitis B with common viral variants can be determined through the interaction between the virus and the host immune response. B cells constitute half of the intrahepatic lymphocyte population with an impact on fibrosis. A proliferation-inducing ligand (APRIL) has been shown to have a co-stimulatory activity on B cells. For this study HBV DNA was amplified and then sequenced to show the presence of the basal core promoter (BCP) mutations in the serum from 57 patients with chronic hepatitis B. The range of IgD-positive B cells was detected by immunohistochemistry in liver biopsies; and patients serum was assayed for APRIL levels by enzyme immunoassay. Twenty-seven patients (47.4%) harbored the A1762T-G1764A BCP mutations. Coefficients of logistic regression showed that the effect of increasing IgD-positive B cells in rising odds of the liver disease is the same in the patients with BCP mutation A1762T-G1764A and in the patients without mutation, nevertheless the effect of APRIL is not similar in these two groups of patients. Logistic regression in patients with BCP A1762T-G1764A mutations demonstrated that increasing one score of APRIL decreased the odds of fibrosis stage about 8%. These results suggest that in infection with viral variants of hepatitis B virus, the population of IgD-positive B cells may play a decisive role in later stages of the liver disease which is reduced by APRIL in chronic hepatitis patients with BCP mutations.
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Affiliation(s)
- Ashraf Mohamadkhani
- Digestive Disease Research Centre, Tehran University of Medical Science, Tehran, Iran
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Ouneissa R, Bahri O, Alaya-Bouafif NB, Chouaieb S, Ben Yahia A, Sadraoui A, Hammami W, Filali N, Azzouz MM, Mami NB, Triki H. Frequency and clinical significance of core promoter and precore region mutations in Tunisian patients infected chronically with hepatitis B. J Med Virol 2013; 84:1719-26. [PMID: 22997074 DOI: 10.1002/jmv.23394] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Genetic variability of hepatitis B virus (HBV) in the C gene and its association with the different stages of chronic liver disease has been studied inadequately with controversial results. The objectives of the current study were to determine the frequency of core promoter and precore mutations in chronic hepatitis B in Tunisia and to evaluate their impact on viral replication and disease progression. Sequencing was performed in upstream regulatory sequence (URS), pre-core (PreC) and basal core promoter (BCP) regions for 123 chronic infected patients by HBV genotype D at different status of disease. Mutations were detected in 98.4% of cases, affecting URS, BCP and Pre-C in 95.1%, 95.9% and 87.8% respectively. Multi-mutations increased significantly from asymptomatic carrier to advanced liver disease status. G1896A (74.8%), G1764A/T/C (71.5%), G1899A (54.4%) and T1678C (52%) were the most common. Special attention should be paid to A1703T, T1678C/G-A1703T, and A1652G-A1679G mutations probably specific of Tunisians sequences; they were observed in 40.6%, 41.5% and 30.1% respectively. A1679G/C, T1753C/G/A, A1762T/G and A1762T-G1764A were more prevalent in older patients. High DNA levels were associated with G1899A or G1764T/C-C1766G-C1799G and advanced liver disease with mutations at positions 1762, 1764 and/or 1899 alone or in double or triple mutations. It was also shown that substitutions at nucleotides 1762, 1764 and 1899 have an impact on the disease progression. It is the first report for specific mutations in the URS region for genotype D. It should be completed by studying eventual correlation with clinical progression and the response to treatment.
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Affiliation(s)
- Rim Ouneissa
- Laboratory of Clinical Virology, Institut Pasteur de Tunis, Tunis, Tunisia
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Ayari R, Lakhoua-Gorgi Y, Bouslama L, Safar I, Kchouk FH, Aouadi H, Jendoubi-Ayed S, Najjar T, Ayed K, Abdallah TB. Investigation of DNA sequence in the Basal core promoter, precore, and core regions of hepatitis B virus from Tunisia shows a shift in genotype prevalence. HEPATITIS MONTHLY 2012; 12:e6191. [PMID: 23346148 PMCID: PMC3549613 DOI: 10.5812/hepatmon.6191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 09/01/2012] [Accepted: 10/02/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND In this study, we evaluated the prevalence of the most common mutations occurring in Enhancer II (EnhII), Basal Core Promoter (BCP), Precore (PC), and Core (C) regions of hepatitis B virus (HBV) genome. OBJECTIVES We also investigated the correlation between HBV variants, their genotypes, and patients' HBe antigen (HBeAg: soluble shape of the capsid antigen) status. PATIENTS AND METHODS We retrieved viral DNA from 40 serum samples of Tunisian patients positive for hepatitis B surface antigen (HBsAg) and HBV DNA, amplified the above mentioned regions using specific primers, and sequenced the corresponding PCR (polymerase chain reaction) products. For further analysis purpose, the patients were divided into two groups: Group1 including 34 HBeAg-negative patients and Group2 with 6 HBeAg-positive patients. RESULTS Twenty-one patients (52.5%) showed PC G1896A mutation and 11 (27.5%) carried A1762T/G1764A double mutations. These mutations were more frequent in HBeAg-negative patients than that in HBeAg-positive ones. Indeed, 58.8% of patients bearing G1896A mutation were HBeAg-negative while 16.7% were positive. In patients bearing T1762/A1764 double mutation, 29.4% were positive and 16.7% were negative. In addition, the A1896 mutation was restricted to HBV isolates that had wild-type T1858, while C1858 was rather linked to the occurrence of T1762/A1764 mutation. Interestingly, this study revealed a high frequency of genotype E. This frequency was important as compared to that of genotype D known to be predominant in the country as delineated in previous studies. CONCLUSIONS Previous results supported and showed that HBV strains present in Tunisia belonging to genotype D and, to a lesser extent, to genotype E, were prone to mutations in BCP/ PC regions. This observation was more obvious in HBV isolates from asymptomatic chronic carriers (AsC). The high mutational rates observed in our study might result from a mechanism of viral escape that plays an important role in the loss of HBeAg.
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Affiliation(s)
- Rym Ayari
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
- Corresponding author: Rym Ayari, Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology (LR03SP01), Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia. Tel.: +216-25462623, Fax: +216-71561156, E-mail:
| | - Yousr Lakhoua-Gorgi
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Lamjed Bouslama
- Borj Cedria Center for Biotechnology, Hammam Lif, Tunis, Tunisia
| | - Imen Safar
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Fatma Houissa Kchouk
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Houda Aouadi
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Saloua Jendoubi-Ayed
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Taoufik Najjar
- Department Gastro-Enterology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Kaled Ayed
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - Taieb Ben Abdallah
- Laboratory of Immunology Research Center, Kidney Transplantation and Immunopathology, Charles Nicolle Hospital, University of Tunis El Manar, Tunis, Tunisia
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Kitab B, Essaid El Feydi A, Afifi R, Trepo C, Benazzouz M, Essamri W, Zoulim F, Chemin I, Alj HS, Ezzikouri S, Benjelloun S. Variability in the precore and core promoter regions of HBV strains in Morocco: characterization and impact on liver disease progression. PLoS One 2012; 7:e42891. [PMID: 22905181 PMCID: PMC3419231 DOI: 10.1371/journal.pone.0042891] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/13/2012] [Indexed: 12/12/2022] Open
Abstract
Background Hepatitis B virus (HBV) is one of the most common human pathogens that cause aggressive hepatitis and advanced liver disease (AdLD), including liver cirrhosis and Hepatocellular Carcinoma. The persistence of active HBV replication and liver damage after the loss of hepatitis B e antigen (HBeAg) has been frequently associated with mutations in the pre-core (pre-C) and core promoter (CP) regions of HBV genome that abolish or reduce HBeAg expression. The purpose of this study was to assess the prevalence of pre-C and CP mutations and their impact on the subsequent course of liver disease in Morocco. Methods/Principal Findings A cohort of 186 patients with HBeAg-negative chronic HBV infection was studied (81 inactive carriers, 69 with active chronic hepatitis, 36 with AdLD). Pre-C and CP mutations were analyzed by PCR-direct sequencing method. The pre-C stop codon G1896A mutation was the most frequent (83.9%) and was associated with a lower risk of AdLD development (OR, 0.4; 95% CI, 0.15–1.04; p = 0.04). HBV-DNA levels in patients with G1896A were not significantly different from the other patients carrying wild-type strains (p = 0.84). CP mutations C1653T, T1753V, A1762T/G1764A, and C1766T/T1768A were associated with higher HBV-DNA level and increased liver disease severity. Multiple logistic regression analysis showed that older age (≥40 years), male sex, high viral load (>4.3 log10 IU/mL) and CP mutations C1653T, T1753V, A1762T/G1764A, and C1766T/T1768A were independent risk factors for AdLD development. Combination of these mutations was significantly associated with AdLD (OR, 7.52; 95% CI, 4.8–8; p<0.0001). Conclusions This study shows for the first time the association of HBV viral load and CP mutations with the severity of liver disease in Moroccan HBV chronic carriers. The examination of CP mutations alone or in combination could be helpful for prediction of the clinical outcome.
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Affiliation(s)
- Bouchra Kitab
- Laboratoire des Hépatites Virales, Institut Pasteur du Maroc, Casablanca, Morocco
- Laboratoire de Recherche sur les Lipoprotéines et l′Athérosclérose, Unité Associée au CNRST -URAC 34- Université Hassan II, Faculté des Sciences Ben M′sik, Casablanca, Morocco
| | | | - Rajaa Afifi
- Service Médecine C, CHU Ibn Sina, Rabat, Morocco
| | | | | | | | | | | | - Hanane Salih Alj
- Laboratoire de Recherche sur les Lipoprotéines et l′Athérosclérose, Unité Associée au CNRST -URAC 34- Université Hassan II, Faculté des Sciences Ben M′sik, Casablanca, Morocco
| | - Sayeh Ezzikouri
- Laboratoire des Hépatites Virales, Institut Pasteur du Maroc, Casablanca, Morocco
| | - Soumaya Benjelloun
- Laboratoire des Hépatites Virales, Institut Pasteur du Maroc, Casablanca, Morocco
- * E-mail:
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Gutiérrez A, Viciana I, Rius F, Pinedo A. [Mutations in precore/basal core promoter regions and viral polymerase in patients with chronic hepatitis B]. Enferm Infecc Microbiol Clin 2011; 30:70-4. [PMID: 22112677 DOI: 10.1016/j.eimc.2011.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 08/16/2011] [Accepted: 08/31/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Variations of C gene give rise to precore and basal core mutations, which influence HBeAg expression The antiviral treatment failure is due to the presence of variations in the gene P, which cause mutations in the viral polymerase. METHODS We performed genotyping of HBV P gene by sequencing, and gene C in patients with chronic hepatitis B over a period of five years. RESULTS A total of 75% of the patients had some mutation in precore or in basal core promoter regions, and 37% demonstrated resistance mutations to antiviral treatment. The most frequent genotypes were A and D. CONCLUSIONS The presence of mutations in core/precore regions in patients with chronic hepatitis has led to tighter control of these patients. Detecting for resistance should be done as quickly as possible before there is an increase in viral load.
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Affiliation(s)
- Ainhoa Gutiérrez
- Servicio de Microbiología, Hospital Virgen de la Victoria, Málaga, España
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24
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Bahri O, Ezzikouri S, Alaya-Bouafif NB, Iguer F, Feydi AEE, Mestiri H, Benazzouz M, Khalfallah T, Afifi R, Elkihal L, Berkane S, Marchio A, Debzi N, Dejean A, Pineau P, Triki H, Benjelloun S. First multicenter study for risk factors for hepatocellular carcinoma development in North Africa. World J Hepatol 2011; 3:24-30. [PMID: 21307984 PMCID: PMC3035699 DOI: 10.4254/wjh.v3.i1.24] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/08/2010] [Accepted: 12/15/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the role of the major risk factors for hepatocellular carcinoma (HCC) development in the western part of North Africa. METHODS A multicenter case control study was conducted in Tunisia, Morocco and Algeria in collaboration with Pasteur Institutes in these countries. A total of 164 patients with HCC and 250 control subjects without hepatic diseases were included. Prevalences of HBsAg, anti-hepatitis C virus (HCV) and diabetes were assessed. HCV and HBV genotyping were performed for anti-HCV and HBsAg positive patients. RESULTS The mean age of patients was 62 ± 10 years old for a 1.5 M:F sex ratio. Sixty percent of HCC patients were positive for anti-HCV and 17.9% for HBsAg. Diabetes was detected in 18% of cases. Odd ratio (OR) and 95% confidence intervals (CI) were 32.0 (15.8 - 65.0), 7.2 (3.2 - 16.1) and 8.0 (3.1 - 20.0) for anti-HCV, HBsAg and diabetes respectively. Multivariate analysis indicated that the three studied factors were independent. 1b HCV genotype and D HBV genotype were predominant in HCC patients. HCV was the only risk factor significantly associated with an excess of cirrhosis (90% vs 68% for all other risk factors collectively, P = 0.00168). Excessive alcohol consumption was reliably established for 19 (17.6%) cases among the 108 HCC patients for whom data is available. CONCLUSION HCV and HBV infections and diabetes are the main determinants of HCC development in North Africa. An active surveillance and secondary prevention programs for patients with chronic hepatitis and nutrition-associated metabolic liver diseases are the most important steps to reduce the risk of HCC in the region.
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Affiliation(s)
- Olfa Bahri
- Olfa Bahri, Hinda Triki, Laboratory of Clinical Virology, Institut Pasteur of Tunis, Tunis, BP 1002, Tunisia
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25
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Hannachi N, Fredj NB, Bahri O, Thibault V, Ferjani A, Gharbi J, Triki H, Boukadida J. Molecular analysis of HBV genotypes and subgenotypes in the Central-East region of Tunisia. Virol J 2010; 7:302. [PMID: 21050489 PMCID: PMC2989323 DOI: 10.1186/1743-422x-7-302] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 11/04/2010] [Indexed: 12/17/2022] Open
Abstract
Background In Tunisia, country of intermediate endemicity for Hepatitis B virus (HBV) infection, most molecular studies on the virus have been carried out in the North of the country and little is known about other regions. The aim of this study was to determine HBV genotype and subgenotypes in Central-East Tunisia. A total of 217 HBs antigen positive patients were enrolled and determination of genotype was investigated in 130 patients with detectable HBV DNA. HBV genotyping methods were: PCR-RFLP on the pre-S region, a PCR using type-specific primers in the S region (TSP-PCR) and partial sequencing in the pre-S region. Results Three genotypes (D, B and A) were detected by the PCR-RFLP method and two (D and A) with the TSP-PCR method, the concordance between the two methods was 93%. Sequencing and phylogenetic analysis of 32 strains, retrieved the same genotype (D and A) for samples with concordant results and genotype D for samples with discordant results. The sequences of discordant genotypes had a restriction site in the pre-S gene which led to erroneous result by the PCR-RFLP method. Thus, prevalence of genotype D and A was 96% and 4%, respectively. Phylogenetic analysis showed the predominance of two subgenotypes D1 (55%) and D7 (41%). Only one strain clustered with D3 subgenotype (3%). Conclusions Predominance of subgenotype D7 appears to occur in northern regions of Africa with transition to subgenotype D1 in the East of the continent. HBV genetic variability may lead to wrong results in rapid genotyping methods and sequence analysis is needed to clarify atypical results.
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Affiliation(s)
- Naila Hannachi
- Laboratoire de Microbiologie-Immunologie, UR02SP13, Hôpital Farhat Hached, Sousse, Tunisia.
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26
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Asim M, Malik A, Sarma MP, Polipalli SK, Begum N, Ahmad I, Khan LA, Husain SA, Akhtar N, Husain S, Thayumanavan L, Singla R, Kar P. Hepatitis B virus BCP, Precore/core, X gene mutations/genotypes and the risk of hepatocellular carcinoma in India. J Med Virol 2010; 82:1115-25. [PMID: 20513073 DOI: 10.1002/jmv.21774] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The study aims to characterize mutations of the HBV genome involving BCP, Precore/core and X regions and also defines HBV genotypes in patients of hepatocellular carcinoma (HCC). The study involved 150 HBV-related HCC cases and 136 HBV-related chronic liver disease patients without HCC as controls. HBV DNA was subjected to mutational analysis using SSCP technique, genotyping by RFLP, and direct nucleotide sequencing. HBV DNA was found in 58.7% (88/150) of the HCC cases and 74.3% (101/136) of controls. HBV mutants were observed in 44.3% of HCC cases and 43.2% of controls. HBV/D was prevalent amongst the patients and controls, followed by HBV/A. The prevalence of the TT1504 mutation in the X gene, the V1753 and T1762/A1764 mutations in the BCP region, and G1914 mutation in the core gene were significantly higher in the HCC group than in the non-HCC group. Multivariate analyses showed that the TT1504, V1753, A1762T/G1764A, and the G1914 mutations and the patient's age, sex, and HBeAg status increased the risk of HCC development significantly. Also, patients with HCC had lower levels of serum albumin, viral load, and platelet counts but higher values of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, bilirubin, and Alpha feto-protein than those of controls (P < 0.001 for all comparisons). HBV/D was the predominant genotype associated with HCC cases seen in India. The presence of different types of HBV mutations, age, sex, HBeAg status, and viral load was found to increase significantly the risk of HCC development in India.
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Affiliation(s)
- Mohammad Asim
- Department of Medicine, Maulana Azad Medical College, University of Delhi, New Delhi, India
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Abdou Chekaraou M, Brichler S, Mansour W, Le Gal F, Garba A, Dény P, Gordien E. A novel hepatitis B virus (HBV) subgenotype D (D8) strain, resulting from recombination between genotypes D and E, is circulating in Niger along with HBV/E strains. J Gen Virol 2010; 91:1609-20. [PMID: 20147517 DOI: 10.1099/vir.0.018127-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Niger is a west African country that is highly endemic for hepatitis B virus (HBV) infection. The seroprevalence for HBV surface antigen (HBsAg) is about 20%; however, there are no reports on the molecular epidemiology of HBV strains spreading in Niger. In the present study, HBV isolates from the sera of 58 consecutive, asymptomatic, HBsAg-positive blood donors were characterized. Genotype affiliation was determined by amplification, sequencing and phylogenetic analysis of the preS1, polymerase/reverse transcriptase (RT/Pol) and precore (preC)/C regions. The first series of results revealed that different genomic fragments clustered with different genotypes on phylogenetic trees, suggesting recombination events. Twenty-four complete genomic sequences were obtained by amplification and sequencing of seven overlapping regions covering the whole genome, and were studied by extensive phylogenetic analysis. Among them, 20 (83.3%) were classified unequivocally as genotype E (HBV/E). The remaining four (16.7%) clustered on a distinct branch within HBV/D with strong bootstrap and posterior probability values. Complete molecular characterization of these four strains was achieved by the Simplot program, bootscanning analysis and cloning experiments, and enabled us to identify an HBV/D-E recombinant that formed a new HBV/D subgenotype spreading in Niger, tentatively named D8. Moreover, 20 new complete HBV/E nucleotide sequences were determined that exhibited higher genetic variability than is generally described in Africa. One was found to be a recombinant containing HBV/D sequences in the preS2 and RT/Pol regions. Taken together, these data suggest that, in Niger, genetic variability of HBV strains is still evolving, probably reflecting ancient endemic HBV infection.
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Affiliation(s)
- Mariama Abdou Chekaraou
- Service de Bactériologie, Virologie, Hygiène, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Laboratoire Associé au Centre National de Référence des Hépatites B, C et Delta, UFR Santé Médecine Biologie Humaine, Université Paris 13, Bobigny, France
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Kamal SM, Mahmoud S, Hafez T, EL-Fouly R. Viral hepatitis a to e in South mediterranean countries. Mediterr J Hematol Infect Dis 2010; 2:e2010001. [PMID: 21415943 PMCID: PMC3033107 DOI: 10.4084/mjhid.2010.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 02/04/2010] [Indexed: 02/06/2023] Open
Abstract
Viral hepatitis represents an important health problem in the South Mediterranean countries, Egypt, Libya, Tunisia, Algeria and Morocco. Emerging natural history and epidemiological information reveal differences in the overall epidemiology, risk factors and modes of transmission of viral hepatitis A, B, C, D, E infections in the South Mediterranean region. The differences in the in incidence and prevalence of viral hepatitis across North African countries is attributed to variations in health care and sanitation standards, risk factors and immunization strategies. The active continuous population movement through travel, tourism and migration from and to the South Mediterranean countries contribute to the spread of infections due to hepatitis viruses across borders leading to outbreaks and emergence of new patterns of infection or introduction of uncommon genotypes in other countries, particularly in Europe.
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Affiliation(s)
- Sanaa M. Kamal
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
| | - Sara Mahmoud
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
| | - Tamer Hafez
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
| | - Runia EL-Fouly
- Department of Tropical Medicine, Gastroenterology and Liver Disease, Ain Shams University, Cairo, Egypt
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29
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Zaky S, Farghaly AM, Rashed HA, Hassan H, Faouzy E, Makhlouf N, Hussein MRA. Clinicopathologic features and genotyping of patients with chronic HBV infection in the Upper Egypt. Cell Immunol 2010; 265:97-104. [DOI: 10.1016/j.cellimm.2010.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/17/2010] [Accepted: 07/24/2010] [Indexed: 02/06/2023]
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30
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Djebbi A, Rebai W, Bahri O, Hogga N, Sadraoui A, Triki H. Marqueurs sérologiques, ARN viral et génotype du virus de l’hépatite delta chez des patients tunisiens antigène HBs positifs. ACTA ACUST UNITED AC 2009; 57:518-23. [DOI: 10.1016/j.patbio.2008.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 09/18/2008] [Indexed: 12/18/2022]
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31
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Mota A, Guedes F, Areias J, Pinho L, Cardoso MF. Epidemiological study of genotypes of hepatitis B virus in northern Portugal. J Med Virol 2009; 81:1170-6. [DOI: 10.1002/jmv.21526] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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32
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Hannachi N, Bahri O, Mhalla S, Marzouk M, Sadraoui A, Belguith A, Triki H, Boukadida J. Hépatite virale B chez les femmes enceintes tunisiennes : facteurs de risque et intérêt de l’étude de la réplication virale en cas d’antigène HBe négatif. ACTA ACUST UNITED AC 2009; 57:e43-7. [DOI: 10.1016/j.patbio.2008.04.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 04/16/2008] [Indexed: 12/29/2022]
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Meldal BHM, Moula NM, Barnes IHA, Boukef K, Allain JP. A novel hepatitis B virus subgenotype, D7, in Tunisian blood donors. J Gen Virol 2009; 90:1622-1628. [PMID: 19339480 DOI: 10.1099/vir.0.009738-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Tunisia is a medium-level epidemic country for hepatitis B virus (HBV). This study characterizes, for the first time, full genome HBV strains from Tunisia. Viral load quantification and phylogenetic analyses of full genome or pre-S/S sequences were performed on 196 hepatitis B surface antigen (HBsAg)-positive plasma samples from Tunisian blood donors. The median viral load was 64.65 IU ml(-1) (range<5-7.7x10(8) IU ml(-1)) and 89% of samples had viral loads below 10,000 IU ml(-1). Fifty-nine strains formed a novel subgenotype D7, 41 strains clustered in subgenotype D1, seven strains in subgenotype A2 and one strain in genotype C. The novel subgenotype D7 was defined by maximum Bayesian posterior probability, a genetic divergence from other HBV/D subgenotypes by >4% and a stronger HBV/E signal in the X to core genes than subgenotype D1. In conclusion, HBV/D is dominant in asymptomatic Tunisian HBsAg carriers and a novel subgenotype, D7, was the most common subgenotype found in this population.
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Affiliation(s)
- Birgit H M Meldal
- Division of Transfusion Medicine, Department of Haematology, University of Cambridge, Cambridge Blood Centre, Long Road, Cambridge CB2 0PT, UK
| | | | - If H A Barnes
- Division of Transfusion Medicine, Department of Haematology, University of Cambridge, Cambridge Blood Centre, Long Road, Cambridge CB2 0PT, UK
| | | | - Jean-Pierre Allain
- Division of Transfusion Medicine, Department of Haematology, University of Cambridge, Cambridge Blood Centre, Long Road, Cambridge CB2 0PT, UK
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Panessa C, Hill WD, Giles E, Yu A, Harvard S, Butt G, Andonov A, Krajden M, Osiowy C. Genotype D amongst injection drug users with acute hepatitis B virus infection in British Columbia. J Viral Hepat 2009; 16:64-73. [PMID: 19192159 DOI: 10.1111/j.1365-2893.2008.01045.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The eight genotypes of hepatitis B virus (HBV) exhibit distinct geographical distributions. This study identified HBV genotypes and transmission modes associated with acute infection in British Columbia (BC), Canada, from 2001 to 2005. Seventy cases of acute HBV in BC were identified from laboratory reports using a standardized case definition. Interviews for risk factors and hepatitis history were conducted for each case. HBV genotypes were determined by BLAST comparison analysis of the surface (S) or preS gene sequence. To illustrate the distribution of genotypes identified amongst acute cases in BC, an annotated map was produced showing the global occurrence of HBV genotypes. The majority of acute HBV cases occurred in Caucasian, Canadian-born males, with 30% of cases reporting injection drug use (IDU) and 21% reporting incarceration. The most common genotype observed was genotype D (62.9%), followed by genotypes A (18.6%), C (11.4%), B (4.3%), and E (1.4%). A significant association was observed between Genotype D and IDU (P = 0.0025) and previous incarceration (P = 0.0067). Phylogenetic analysis of the S gene sequence demonstrated identical or high genetic relatedness amongst genotype D viral strains (86% sub-genotype D3), thus verifying transmission clustering amongst BC injection drug users. The association between acute HBV genotype and reported transmission modes has not been previously described in North America. Tracking of genotypes can help identify disease transmission patterns and target at-risk populations for preventive immunization.
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Affiliation(s)
- C Panessa
- BC Centre for Disease Control, Vancouver, BC, Canada
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Hepatitis B virus genotype E variability in Africa. J Clin Virol 2008; 43:376-80. [PMID: 18922739 DOI: 10.1016/j.jcv.2008.08.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 08/14/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND In sub-Saharan Africa, genotype E is the predominant genotype throughout a vast region spanning from Senegal to Namibia and extending to the Central African Republic in the East. Despite its wide geographic distribution and the high prevalence throughout this genotype E crescent, this genotype has a very low genetic diversity. OBJECTIVES Here we review our current understanding of genotype E reanalysing all currently available sequences of the S gene and the complete genome. RESULTS Phylogenetic analysis of the complete genome sequences confirmed a previously suggested South-West/Central African cluster and several lineages of West African sequences. The overall mean genetic distance was 1.71%, with the more Southern countries of the genotype E crescent exhibiting lower distances than the Northern countries. CONCLUSIONS Genotype E seems to have a longer natural history in the Northern part of the genotype E crescent than in the Southern countries. As genotype E is essentially absent from the Americas despite the Afro-American slave trade until at least the beginning of the 19th century, genotype E strains may have been introduced into the general African population only within the past 200 years. How the virus may have spread throughout the genotype E crescent warrants further investigation.
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Khelifa F, Thibault V. [Characteristics of hepatitis B viral strains in chronic carrier patients from North-East Algeria]. ACTA ACUST UNITED AC 2008; 57:107-13. [PMID: 18835106 DOI: 10.1016/j.patbio.2008.07.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 07/04/2008] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The goal of the study was to determine the characteristics of chronic hepatitis B virus (HBV) infections in the north-east part of Algeria. Chronic HBV infection remains a global public health issue and Algeria is considered as an intermediate prevalence area. Improving our knowledge on the epidemiology of this infection is a prerequisite to adopt the best preventive and curative strategy. MATERIAL AND METHODS We have studied 75 chronic hepatitis B patients from north-east Algeria. The characteristics of HBV strains were determined by use of serological and molecular testing. Genes encoding part of the precore, the surface and the polymerase were sequenced and phylogenetically analyzed. RESULTS Median age of the patients was 35 years and 80% of them had normal transaminase level. Liver histological lesions were identified in 63% of the patients who benefited from a liver biopsy and 21% of them had cirrhosis. Median viral replication was 3.9 Log IU/ml and 87% of patients had a "precore" mutant serological profile without HBe Ag. Genotype D was predominant (93%) followed by genotype A (5%) and E for one patient. Algerian strains clustered independently from other genotype D reference sequences, suggesting a possible new D subtype. Within the "precore" region, only 16% of the strains did not show any mutation at positions 1762/1764 and 1896. CONCLUSION In this original set of patients from north Algeria, the virologic characteristics of HBV are comparable to what has been described in other Mediterranean countries. Our study raises several important aspects with regard to the prevention and treatment of chronic hepatitis B in Algeria.
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Affiliation(s)
- F Khelifa
- Laboratoire d'hygiène de la Wilaya, institut Pasteur d'Algérie, cité Daksi, Constantine, Algérie.
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Elkady A, Tanaka Y, Kurbanov F, Oynsuren T, Mizokami M. Virological and clinical implication of core promoter C1752/V1753 and T1764/G1766 mutations in hepatitis B virus genotype D infection in Mongolia. J Gastroenterol Hepatol 2008; 23:474-81. [PMID: 18318825 DOI: 10.1111/j.1440-1746.2008.05321.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The aim of the present study was to reveal virological and clinical features of hepatitis B virus (HBV) genotype D infection. METHODS One hundred and twenty-two Mongolian chronic liver disease (CLD) patients infected with HBV were subjected for serological HBV-markers screening and HBV-enzyme immunoassay (EIA) genotyping. Nucleotide sequences were analyzed for 48 HBV/D strains (23 isolated from hepatocellular carcinoma (HCC) and 25 from CLD patients). RESULTS Prevalence of hepatitis B e antigen (HBeAg) positivity was low (25.9%) in young patients (< or =30 years old) indicating early HBeAg seroclearance in HBV/D carriers. The T1764/G1766 double mutation was the most common basal core promoter (BCP) mutation (29.2%) and was frequent in HBeAg-negative patients (39.3%). Patients harboring T1764/G1766 mutants exhibited lower HBV-DNA and HBV core antigen (HBcAg) levels than those with wild-type BCP strains (P = 0.024, 0.049, respectively). C1752 and/or V (not T) 1753 mutation was significantly prevalent in HCC patients (HCC vs CLD; 52.2% vs 20%, P = 0.033). T1762/A1764 mutation was detected in 75.0% of HCC patients with high viral load (> or =5 log copies/mL). Precore stop codon mutation A1896 was detected in (70.8%) of HBV/D-infected patients. CONCLUSIONS In Mongolians infected with HBV/D, C1752 and/or V1753 mutation was associated with HCC.
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Affiliation(s)
- Abeer Elkady
- Department of Clinical Molecular Informative Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Kramvis A, Kew MC. Epidemiology of hepatitis B virus in Africa, its genotypes and clinical associations of genotypes. Hepatol Res 2007; 37:S9-S19. [PMID: 17627641 DOI: 10.1111/j.1872-034x.2007.00098.x] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Of approximately 360 million people in the world chronically infected with hepatitis B virus (HBV), 65 million reside in Africa. Thus, Africa, with 12% of the world's population, carries approximately 18% of the global burden of HBV infection, with hepatocellular carcinoma and cirrhosis accounting for 2% of the continent's annual deaths. Despite HBV being endemic or hyperendemic in Africa, there is a paucity of data on the genotypes and their distribution. Genotype A is found mainly in southern, eastern and central Africa. Most African genotype A strains belong to subgenotype A1, with subgenotype A3 found in western Africa. Genotype D prevails in northern countries and genotype E in western and central Africa. Ithas become increasingly evident that heterogeneity in the global distribution of HBV genotypes may be responsible for differences in the clinical outcomes of HBV infections and the response to antiviral treatment and vaccination. A limited number of studies have been published relating genotypes to clinical outcomes in African countries. Because observations from other regions of the world can not be extrapolated from one locale to another, the HBV strains circulating in Africa should be studied and related to clinical outcomes.
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Affiliation(s)
- Anna Kramvis
- MRC/University Molecular Hepatology Research Unit, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Abdo AA, Al-Jarallah BM, Sanai FM, Hersi AS, Al-Swat K, Azzam NA, Al-Dukhayil M, Al-Maarik A, Al-Faleh FZ. Hepatitis B genotypes: relation to clinical outcome in patients with chronic hepatitis B in Saudi Arabia. World J Gastroenterol 2006; 12:7019-24. [PMID: 17109498 PMCID: PMC4087347 DOI: 10.3748/wjg.v12.i43.7019] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 09/15/2006] [Accepted: 09/27/2006] [Indexed: 02/06/2023] Open
Abstract
AIM To identify the most common hepatitis B virus (HBV) genotype in Saudi Arabia, and correlate the prevailing genotypes with the clinical outcome of patients. METHODS Patients were consecutively recruited from the hepatology clinics of two tertiary care referral centers. Patients were categorized into 4 different groups: group 1, patients with hepatitis B and normal liver enzymes; group 2, patients with hepatitis B and abnormal liver enzymes but without cirrhosis; group 3, patients with hepatitis B and liver cirrhosis; group 4, patients with hepatitis B and hepatocellular carcinoma. All patients had a positive hepatitis B surface antigen (HBsAg). Genotyping of HBV was performed by nested PCR-mediated amplification of the target sequence and hybridization with sequence-specific oligonucleotides. RESULTS Seventy patients were enrolled in this study. They were predominantly male (72.9%) in their mid-forty's (mean age 47 years). Forty-nine (70%) patients were hepatitis B envelope antigen (HBeAg) negative. The majority of patients (64%) acquired HBV through unknown risk factors. Hepatitis B genotyping revealed that 57 patients (81.4%) were genotype D, 1 patient (1.4%) had genotype A, 1 patient (1.4%) had genotype C, and 4 patients (5.7%) had genotype E, while 7 patients (10%) had mixed genotype (4 patients ADG, 1 patient DE, 1 patient DF, and 1 patient ADFG). Based on univariate analysis of genotype D patients, significant predictors of advanced liver disease were age, gender, aspartate transaminase, alanine transaminase, albumin, bilirubin, and alkaline phosphatase (all P < 0.001). In multivariate analysis decreased hemoglobin (r = -0.05; 95% CI: -0.08 to -0.03; P = 0.001) and albumin levels (r = -0.004; 95% CI: -0.007 to -0.001; P = 0.002) were highly significant predictors of advanced liver disease. In patients with HBV genotype D, HBeAg negativity was found to increase across advancing stages of liver disease (P = 0.024). CONCLUSION This study highlights that the vast majority of Saudi patients with chronic hepatitis B have genotype D. No correlation could be observed between the different genotypes and epidemiological or clinical factors. The relationship between genotype D and HBeAg status in terms of disease severity needs to be further elucidated in larger longitudinal studies.
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Affiliation(s)
- Ayman A Abdo
- Gastroenterology Divison, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.
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