1
|
Manuylov V, Chulanov V, Bezuglova L, Chub E, Karlsen A, Kyuregyan K, Ostankova Y, Semenov A, Osipova L, Tallo T, Netesova I, Tkachuk A, Gushchin V, Netesov S, Magnius LO, Norder H. Genetic Diversity and Possible Origins of the Hepatitis B Virus in Siberian Natives. Viruses 2022; 14:2465. [PMID: 36366563 PMCID: PMC9693834 DOI: 10.3390/v14112465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
A total of 381 hepatitis B virus (HBV) DNA sequences collected from nine groups of Siberian native populations were phylogenetically analyzed along with 179 HBV strains sampled in different urban populations of former western USSR republics and 50 strains from Central Asian republics and Mongolia. Different HBV subgenotypes predominated in various native Siberian populations. Subgenotype D1 was dominant in Altaian Kazakhs (100%), Tuvans (100%), and Teleuts (100%) of southern Siberia as well as in Dolgans and Nganasans (69%), who inhabit the polar Taimyr Peninsula. D2 was the most prevalent subgenotype in the combined group of Nenets, Komi, and Khants of the northern Yamalo-Nenets Autonomous Region (71%) and in Yakuts (36%) from northeastern Siberia. D3 was the main subgenotype in South Altaians (76%) and Buryats (40%) of southeastern Siberia, and in Chukchi (51%) of the Russian Far East. Subgenotype C2 was found in Taimyr (19%) and Chukchi (27%), while subgenotype A2 was common in Yakuts (33%). In contrast, D2 was dominant (56%) in urban populations of the former western USSR, and D1 (62%) in Central Asian republics and Mongolia. Statistical analysis demonstrated that the studied groups are epidemiologically isolated from each other and might have contracted HBV from different sources during the settlement of Siberia.
Collapse
Affiliation(s)
- Victor Manuylov
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Vladimir Chulanov
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases, 127473 Moscow, Russia
- Chair of Infectious Diseases, Sechenov University, 119048 Moscow, Russia
| | - Ludmila Bezuglova
- Hepatitis B ELISA Department, Vector-Best JSC, 630559 Koltsovo, Russia
| | - Elena Chub
- Department of Molecular Virology of Flaviviruses and Viral Hepatitis, State Research Center of Virology and Biotechnology “Vector” of the Rospotrednadzor, 630559 Koltsovo, Russia
| | - Anastasia Karlsen
- Department of Viral Hepatitis, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia
- Scientific and Educational Resource Center for High-Performance Methods of Genomic Analysis, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Karen Kyuregyan
- Department of Viral Hepatitis, Russian Medical Academy of Continuous Professional Education, 125993 Moscow, Russia
- Laboratory of Viral Hepatitis, Mechnikov Research Institute of Vaccines and Sera, 105064 Moscow, Russia
- Scientific and Educational Resource Center for High-Performance Methods of Genomic Analysis, Peoples’ Friendship University of Russia (RUDN University), 117198 Moscow, Russia
| | - Yulia Ostankova
- Laboratory of Molecular Immunology, Institute Pasteur in Saint Petersburg for Research in Epidemiology and Microbiology of the Rospotrednadzor, 197101 Saint-Petersburg, Russia
| | - Alexander Semenov
- Ekaterinburg Research Institute of Viral Infections of SRC VB Vector, 620030 Ekaterinburg, Russia
| | - Ludmila Osipova
- Laboratory of Populational Ethnogenetics, Department of Molecular Diagnostics and Epidemiology, Institute of Cytology and Genetics, 630090 Novosibirsk, Russia
| | - Tatjana Tallo
- Department of Microbiology, Public Health Agency of Sweden, 171 82 Stockholm, Sweden
| | - Irina Netesova
- Hepatitis B ELISA Department, Vector-Best JSC, 630559 Koltsovo, Russia
| | - Artem Tkachuk
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Vladimir Gushchin
- Gamaleya National Research Center of Epidemiology and Microbiology, 123098 Moscow, Russia
| | - Sergey Netesov
- Laboratory of Bionanotechnology, Microbiology and Virology, Novosibirsk State University, 630090 Novosibirsk, Russia
| | | | - Heléne Norder
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, 413 90 Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| |
Collapse
|
2
|
Hashimoto K, Miura K, Takaoka Y, Nomoto H, Watanabe S, Tsukui M, Morimoto N, Isoda N, Nagashima S, Takahashi M, Okamoto H, Yamamoto H. A 79-year-old Woman with Acute Hepatitis B Caused by the Infection of Subgenotype D1 Hepatitis B Virus in Japan: A Case Study. Intern Med 2018; 57:3099-3104. [PMID: 29877273 PMCID: PMC6262716 DOI: 10.2169/internalmedicine.0977-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 79-year-old Japanese woman was diagnosed with acute hepatitis B based on laboratory tests showing positivity for IgM-class antibody against hepatitis B virus (HBV) core and hepatitis B surface antigen (HBsAg) as well as elevated transaminases. A phylogenetic analysis revealed that the HBV strain obtained from the patient belonged to genotype D/subgenotype D1, similar to strains circulating in foreign countries but different from those in Japan. The clinical course was favorable. HBsAg became negative within 10 weeks after the onset. To our knowledge, this is the first report of acute hepatitis B caused by subgenotype D1 HBV in Japan.
Collapse
Affiliation(s)
- Kosei Hashimoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Kouichi Miura
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Yoshinari Takaoka
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Hiroaki Nomoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Shunji Watanabe
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Mamiko Tsukui
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Naoki Morimoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Norio Isoda
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Shigeo Nagashima
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Japan
| | - Masaharu Takahashi
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Japan
| | - Hiroaki Okamoto
- Division of Virology, Department of Infection and Immunity, Jichi Medical University School of Medicine, Japan
| | - Hironori Yamamoto
- Division of Gastroenterology, Department of Medicine, Jichi Medical University School of Medicine, Japan
| |
Collapse
|
3
|
Abstract
BACKGROUND More and more studies focus on the relationship between hepatitis B virus (HBV) basal core promoter/precore (BCP/PC) mutations, but it remains controvercial, we conducted a meta-analysis to investigate the features of hepatitis B virus basal core promoter/precore mutations on the progression of hepatocellular carcinoma (HCC). METHODS A comprehensive search was conducted for articles published between January 1, 2005 and December 31, 2015 using the following databases: PubMed, Embase, Cochrane Library, Wanfang, and China National Knowledge Infrastructure. Medical subject heading terms were prioritized in setting the search strategy. Search terms included ("hepatitis B virus"), ("mutation or mutations or mutant"), and ("hepatocellular carcinoma" or "liver cancer" or hepatoma). A meta-analysis of pooled results from case-control studies examined the association between mutations G1896A, A1762T, G1764A, and A1762T/G1764A and the risk of HCC. RESULTS We included 29 articles for analysis and found that G1896A (summary odds ratios [OR] = 2.04, 95% confidence interval [CI] = 1.41-2.95), A1762T (summary OR = 3.96, 95% CI = 1.98-7.92), G1764A (summary OR = 3.48, 95% CI = 1.99-6.09), and A1762T/G1764A (summary OR = 3.96, 95% CI = 2.77-5.65) are each associated with a statistically significant increase in the risk of HCC. CONCLUSION In summary, we found that G1896A, A1762T, G1764A, and A1762T/G1764A are associated with an increased risk of HCC.
Collapse
Affiliation(s)
- Fangfang Wei
- Department of Infectious Disease, Guangdong Second Provincial General Hospital
| | | | - Maoyin Li
- Department of Urology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Maosheng Wu
- Department of Infectious Disease, Guangdong Second Provincial General Hospital
| |
Collapse
|
4
|
Baser O, Altinbas A, Baser E, Kariburyo MF. Economic Impact and Complications of Treated and Untreated Hepatitis C Virus Patients in Turkey. Value Health Reg Issues 2015; 7:42-48. [PMID: 29698151 DOI: 10.1016/j.vhri.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 07/28/2015] [Accepted: 08/11/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND According to the Turkish Ministry of Health's guidelines, standard double therapy, a combination of pegylated interferon-alpha and ribavirin, was the only treatment option for patients with hepatitis C virus (HCV) infection until the end of 2011. OBJECTIVE The primary objective was to compare risk-adjusted clinical and economic outcomes between treated and untreated patients with HCV infection. METHODS Patients with HCV infection were identified from the Turkish National Health Insurance Database (2009-2011) using International Classification of Diseases, 10th Revision, Clinical Modification codes. The first prescription date was designated as the index date. Mortality and hepatocellular carcinoma (HCC) rates and health care costs of treated and untreated patients were compared using propensity score matching. Baseline demographic and clinical factors were controlled in the models. Subgroup analysis was conducted for patient groups with and without a cirrhosis diagnosis. RESULTS Out of 12,990 patients included in the study, 1,583 were treated for HCV infection. Out of 2,467 patients who had a cirrhosis diagnosis, 231 were treated, whereas out of 10,523 patients without cirrhosis, 1,352 patients were treated. Treated patients were younger, less likely to be diagnosed with comorbid conditions, and less likely to reside in Central or Eastern Anatolia. After adjusting for baseline demographic and clinical factors, mortality (2.27% vs. 5.31%; P < 0.001) and HCC rates (0.69% vs. 1.96%; P < 0.001) were found to be lower for treated patients. Differences were more significant among patients diagnosed with cirrhosis. Treated patients incurred higher risk-adjusted annual costs (€6172 vs. €1680; P < 0.001), mainly because of pharmaceutical costs (€4918 vs. €583; P < 0.001). CONCLUSIONS HCV infection treatment, although costly, significantly reduces mortality and HCC rates in Turkey.
Collapse
Affiliation(s)
- Onur Baser
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA; Department of Economics, MEF University, Istanbul, Turkey; STATinMED Research, New York, NY, USA.
| | - Akif Altinbas
- Diskapi Yildirim Beyazit Education and Research Hospital, Gastroenterology Clinic, Ankara, Turkey
| | - Erdem Baser
- Department of Economics, Gazi University, Ankara, Turkey
| | | |
Collapse
|
5
|
Epidemiology of HBV subgenotypes D. Clin Res Hepatol Gastroenterol 2015; 39:28-37. [PMID: 25037178 DOI: 10.1016/j.clinre.2014.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/09/2014] [Accepted: 06/02/2014] [Indexed: 02/04/2023]
Abstract
The natural history of hepatitis B virus infection is not uniform and affected from several factors including, HBV genotype. Genotype D is a widely distributed genotype. Among genotype D, several subgenotypes differentiate epidemiologically and probably clinically. D1 is predominant in Middle East and North Africa, and characterized by early HBeAg seroconversion and low viral load. D2 is seen in Albania, Turkey, Brazil, western India, Lebanon, and Serbia. D3 was reported from Serbia, western India, and Indonesia. It is a predominant subgenotype in injection drug use-related acute HBV infections in Europe and Canada. D4 is relatively rare and reported from Haiti, Russia and Baltic region, Brazil, Kenya, Morocco and Rwanda. Subgenotype D5 seems to be common in Eastern India. D6 has been reported as a rare subgenotype from Indonesia, Kenya, Russia and Baltic region. D7 is the main genotype in Morocco and Tunisia. D8 and D9 are recently described subgenotypes and reported from Niger and India, respectively. Subgenotypes of genotype D may have clinical and/or viral differences. More subgenotype studies are required to conclude on subgenotype and its clinical/viral characteristics.
Collapse
|
6
|
Ghaziani T, Sendi H, Shahraz S, Zamor P, Bonkovsky HL. Hepatitis B and liver transplantation: molecular and clinical features that influence recurrence and outcome. World J Gastroenterol 2014; 20:14142-55. [PMID: 25339803 PMCID: PMC4202345 DOI: 10.3748/wjg.v20.i39.14142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/29/2014] [Accepted: 05/25/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatitis B virus (HBV) continues to be a major cause of morbidity and mortality worldwide. It is estimated that about 350 million people throughout the world are chronically infected with HBV. Some of these people will develop hepatic cirrhosis with decompensation and/or hepatocellular carcinoma. For such patients, liver transplantation may be the only hope for cure or real improvement in quality and quantity of life. Formerly, due to rapidity of recurrence of HBV infection after liver transplantation, usually rapidly progressive, liver transplantation was considered to be contraindicated. This changed dramatically following the demonstration that hepatitis B immune globulin (HBIG), could prevent recurrent HBV infection. HBIG has been the standard of care for the past two decades or so. Recently, with the advent of highly active inhibitors of the ribose nucleic acid polymerase of HBV (entecavir, tenofovir), there has been growing evidence that HBIG needs to be given for shorter lengths of time; indeed, it may no longer be necessary at all. In this review, we describe genetic variants of HBV and past, present, and future prophylaxis of HBV infection during and after liver transplantation. We have reviewed the extant medical literature on the subject of infection with the HBV, placing particular emphasis upon the prevention and treatment of recurrent HBV during and after liver transplantation. For the review, we searched PubMed for all papers on the subject of "hepatitis B virus AND liver transplantation". We describe some of the more clinically relevant and important genetic variations in the HBV. We also describe current practices at our medical centers, provide a summary and analysis of comparative costs for alternative strategies for prevention of recurrent HBV, and pose important still unanswered questions that are in need of answers during the next decade or two. We conclude that it is now rational and cost-effective to decrease and, perhaps, cease altogether, the routine use of HBIG during and following liver transplantation for HBV infection. Here we propose an individualized prophylaxis regimen, based on an integrated approach and risk-assessment.
Collapse
|
7
|
Batirel A, Guclu E, Arslan F, Kocak F, Karabay O, Ozer S, Turanli M, Mert A. Comparable efficacy of tenofovir versus entecavir and predictors of response in treatment-naïve patients with chronic hepatitis B: a multicenter real-life study. Int J Infect Dis 2014; 28:153-9. [PMID: 25286184 DOI: 10.1016/j.ijid.2014.09.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/05/2014] [Accepted: 09/15/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To compare responses to tenofovir (TDF) and entecavir (ETV) therapy. METHODS This was a multicenter retrospective study including treatment-naïve patients with chronic hepatitis B (CHB) who received TDF or ETV. The primary end-points were undetectable HBV-DNA at 48 weeks and serological and biochemical responses. RESULTS Out of 195 CHB patients, 90 (46%) received TDF and 105 (54%) received ETV; 72% were male, their mean age was 43±12 years, and the mean duration of treatment was 30.2±15.7 months. Hepatitis B e antigen (HBeAg) seropositivity was 32% in the TDF group and 34% in the ETV group. HBeAg seroconversion rates in HBeAg-positive patients were 24% in the TDF group and 39% in the ETV group; the difference was not significant (p=0.2). The mean time to alanine aminotransferase (ALT) normalization and rates of ALT normalization at 3, 6, 12, 18, and 24 months were similar in the two groups (p > 0.05). The mean time to undetectable HBV-DNA levels in the TDF and ETV groups was 11.5±8.9 and 12.9±10.8 months, respectively (p=0.32). A significantly greater decline in HBV-DNA levels at 12 and 18 months was observed in the TDF group (p=0.02 and p=0.03, respectively). Seven (7%) patients on ETV therapy had virological breakthrough (p=0.01). Only one patient in each group had hepatitis B surface antigen (HBsAg) clearance. None of the patients developed decompensation or hepatocellular carcinoma during treatment. CONCLUSIONS The two drugs appear to have similar efficacy in CHB patients. However, 7% of patients on ETV therapy had virological breakthrough, while none of the patients on TDF therapy did.
Collapse
Affiliation(s)
- Ayse Batirel
- Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Semsi Denizer Cd. E-5 Karayolu Cevizli Mevkii, 34890 Kartal, Istanbul, Turkey.
| | - Ertugrul Guclu
- Infectious Diseases and Clinical Microbiology, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Ferhat Arslan
- Infectious Diseases, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| | - Funda Kocak
- Infectious Diseases and Clinical Microbiology, Basaksehir State Hospital, Istanbul, Turkey
| | - Oguz Karabay
- Infectious Diseases and Clinical Microbiology, Medical Faculty, Sakarya University, Sakarya, Turkey
| | - Serdar Ozer
- Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Semsi Denizer Cd. E-5 Karayolu Cevizli Mevkii, 34890 Kartal, Istanbul, Turkey
| | | | - Ali Mert
- Infectious Diseases, Medical Faculty, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
8
|
Sunbul M. Hepatitis B virus genotypes: Global distribution and clinical importance. World J Gastroenterol 2014; 20:5427-5434. [PMID: 24833873 PMCID: PMC4017058 DOI: 10.3748/wjg.v20.i18.5427] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/20/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023] Open
Abstract
At least 600000 individuals worldwide annually die of hepatitis B virus (HBV)-related diseases, such as chronic hepatitis B (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC). Many viral factors, such as viral load, genotype, and specific viral mutations, are known to affect disease progression. HBV reverse transcriptase does not have a proofreading function, therefore, many HBV genotypes, sub-genotypes, mutants, and recombinants emerge. Differences between genotypes in response to antiviral treatment have been determined. To date, 10 HBV genotypes, scattered across different geographical regions, have been identified. For example, genotype A has a tendency for chronicity, whereas viral mutations are frequently encountered in genotype C. Both chronicity and mutation frequency are common in genotype D. LC and progression to HCC are more commonly encountered with genotypes C and D than the other genotypes. Pathogenic differences between HBV genotypes explain disease intensity, progression to LC, and HCC. In conclusion, genotype determination in CHB infection is important in estimating disease progression and planning optimal antiviral treatment.
Collapse
|
9
|
Khan A, Al Balwi MA, Tanaka Y, Hajeer A, Sanai FM, Al Abdulkarim I, Al Ayyar L, Badri M, Saudi D, Tamimi W, Mizokami M, Al Knawy B. Novel point mutations and mutational complexes in the enhancer II, core promoter and precore regions of hepatitis B virus genotype D1 associated with hepatocellular carcinoma in Saudi Arabia. Int J Cancer 2013; 133:2864-2871. [PMID: 23740667 DOI: 10.1002/ijc.28307] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 05/14/2013] [Indexed: 10/10/2023]
Abstract
In this study, a cohort of 182 patients [55 hepatocellular carcinoma (HCC) and 127 non-HCC] infected with hepatitis B virus (HBV) in Saudi Arabia was investigated to study the relationship between sequence variation in the enhancer II (EnhII), basal core promoter (BCP) and precore regions of HBV genotype D (HBV/D) and the risk of HCC. HBV genotypes were determined by sequencing analysis and/or enzyme-linked immunosorbent assay. Variations in the EnhII, BCP and precore regions were compared between 107 non-HCC and 45 HCC patients infected with HBV/D, followed by age-matched analysis of 40 cases versus equal number of controls. Age and male gender were significantly associated with HCC (p = 0.0001 and p = 0.03, respectively). Serological markers such as aspartate aminotransferase, albumin and anti-HBe were significantly associated with HCC (p = 0.0001 for all), whereas HBeAg positivity was associated with non-HCC (p = 0.0001). The most prevalent HBV genotype was HBV/D (94%), followed by HBV/E (4%), HBV/A (1.6%) and HBV/C (0.5%). For HBV/D1, genomic mutations associated with HCC were T1673/G1679, G1727, C1741, C1761, A1757/T1764/G1766, T1773, T1773/G1775 and C1909. Age- and gender-adjusted stepwise logistic regression analysis indicated that mutations G1727 [odds ratio (OR) = 18.3; 95% confidence interval (CI) = 2.8-118.4; p = 0.002], A1757/T1764/G1766 (OR = 4.7; 95% CI = 1.3-17.2; p = 0.01) and T1773 (OR = 14.06; 95% CI = 2.3-84.8; p = 0.004) are independent predictors of HCC development. These results implicate novel individual and combination patterns of mutations in the X/precore region of HBV/D1 as predictors of HCC. Risk stratification based on these mutation complexes would be useful in determining high-risk patients and improving diagnostic and treatment strategies for HBV/D1.
Collapse
Affiliation(s)
- Anis Khan
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Virology and Liver Unit, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|