Diversity of core promoter mutations in immune clearance phase of chronic HBV infection

Evolution of hepatitis B genotype C viral quasi-species during hepatitis B e antigen seroconversion

BACKGROUND & AIMS

Although the evolution of viral quasi-species may be related to the pathological status of disease, little is known about this phenomenon in hepatitis B, particularly with respect to hepatitis B e antigen (HBeAg) seroconversion.

METHODS

Nucleotide sequences of the hepatitis B virus (HBV) X/precore/core region was analyzed at five time-points in four groups of chronic hepatitis B patients, interferon-induced seroconverters (IS, N = 9), interferon non-responders (IN, N = 9), spontaneous seroconverters (SS, N = 9), and non-seroconverters (SN, N = 9) followed during 60 months on an average. Only patients with genotype C were studied.

RESULTS

Analysis of 1800 nucleotide sequences showed that there was no statistical difference between the nucleotide genetic distances of seroconverters (IS and SS; 6.9 × 10⁻³ substitutions (st)/site and 6.7 × 10⁻³ st/site, respectively) and those of non-seroconverters (IN and SN; 5.3 × 10⁻³ st/site and 3.8 × 10⁻³ st/site, respectively) before seroconversion. Compared to non-seroconverters (IN and SN; 5.1 × 10⁻³ st/site and 5.9 × 10⁻³ st/site, respectively), the sequence diversity of seroconverters (IS and SS; 10.9 × 10⁻³ st/site and 9.9 × 10⁻³ st/site, respectively) was significantly higher after seroconversion (p < 0.05), and was higher in seroconverters after seroconversion than before seroconversion (p < 0.05), while this changed very little in non-seroconverters during the observation period. Phylogenetic trees showed greater complexity in secoconverters than non-seroconverters. Parsimony-based estimation of the direction of sequence change between descendants and ancestors before HBeAg seroconversion, revealed higher frequencies of transversional A to T substitution in seroconverters (0.06 vs. 0.02, p = 0.0036) that coincided with the dynamics of quasi-species possessing A1762T mutation.

CONCLUSIONS

The distinctly greater viral diversity in HBeAg seroconverters after seroconversion could be related to escape mutants resulting from stronger selection pressure.

Genetic variations of hepatitis B virus

The emergence of hepatitis B virus genetic variants occurs under the influence of host immunity, immunization, the use of immune globulin or antiviral chemotherapy. Most of these are probably the result of the 'immune escape' phenomenon. Some variants, in particular those in the precore and core promoter regions, have been associated with disease severity and progression. Surface antigen variants have implications for the accuracy of laboratory diagnosis and may reduce the effectiveness of vaccination. Polymerase variants are selected as a result of the use of antiviral chemotherapeutic agents. It is important to monitor the occurrence of these variants.