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Lumley SF, Delphin M, Mokaya JF, Tan CCS, Martyn E, Anderson M, Li KC, Waddilove E, Sukali G, Downs LO, Said K, Okanda D, Campbell C, Harriss E, Shimakawa Y, Matthews PC. A systematic review and meta-analysis of the risk of hepatitis B virus (HBV) resistance in people treated with entecavir or tenofovir. J Clin Virol 2024; 174:105711. [PMID: 38991458 DOI: 10.1016/j.jcv.2024.105711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND As nucleos/tide analogue (NA) therapy (e.g. entecavir and tenofovir) for chronic Hepatitis B virus (HBV) infection becomes more widely indicated and available, understanding drug resistance is essential. A systematic review to quantify resistance to these agents has not previously been undertaken. METHODS We performed a systematic review and random-effects meta-analysis to estimate the risk of HBV resistance to entecavir and tenofovir. We searched nine databases up to 29-Aug-23. We included studies of HBV infection featuring >10 individuals, written in English, reporting treatment ≥48 weeks, with assessment of HBV resistance based on viral sequence data. Data were analysed according to prior exposure history to NA, and choice of NA agent. Analyses were performed in R. FINDINGS 62 studies involving a total of 12,358 participants were included. For entecavir, in treatment-naive individuals (22 studies; 4326 individuals), resistance increased over time to 0.9 % at ≥5 years (95 %CI 0.1-2.3 %), and resistance was increased in NA-experienced individuals (18 studies; 1112 individuals), to 20.1 % (95 %CI 1.6-50.1 %) at ≥5 years. For tenofovir, pooled resistance risk was 0.0 % at all time points, whether previously NA naive (11 studies; 3778 individuals) or experienced (19 studies; 2059 individuals). There was a lack of consistent definitions, poor global representation and insufficient metadata to support subgroup analysis. INTERPRETATION We have generated the first pooled estimates of HBV entecavir and tenofovir resistance over time. HBV resistance to entecavir in treatment-experienced groups in particular may represent a clinical and public health challenge. To date, tenofovir appears to have an excellent resistance profile, but due to data gaps, we caution that existing studies under-estimate the true real-world risk of resistance. Robust prospective data collection is crucial to reduce health inequities and reduce blind-spots in surveillance as treatment is rolled out more widely.
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Affiliation(s)
- Sheila F Lumley
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, UK.
| | | | | | | | - Emily Martyn
- The Francis Crick Institute, 1 Midland Road, London, UK
| | - Motswedi Anderson
- The Francis Crick Institute, 1 Midland Road, London, UK; Africa Health Research Institute, Durban, SA
| | - Ka Chun Li
- The Francis Crick Institute, 1 Midland Road, London, UK
| | | | - Gloria Sukali
- University of KwaZulu Natal, Nelson R Mandela Medical School,Durban, SA
| | - Louise O Downs
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, UK; KEMRI-Wellcome Trust, Kilifi, Kenya
| | - Khadija Said
- The Francis Crick Institute, 1 Midland Road, London, UK
| | | | - Cori Campbell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, UK
| | - Yusuke Shimakawa
- Institut Pasteur, Université Paris Cité, Unité d'Épidémiologie des Maladies Émergentes, Paris, France
| | - Philippa C Matthews
- The Francis Crick Institute, 1 Midland Road, London, UK; Department of Infectious Diseases, University College London Hospitals, London, UK; Division of Infection and Immunity, University College London, Gower Street, London, UK
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Sumer U, Sayan M. Molecular Epidemiology of Hepatitis B Virus in Turkish Cypriot. Pol J Microbiol 2019; 68:449-456. [PMID: 31880889 PMCID: PMC7260636 DOI: 10.33073/pjm-2019-044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 12/11/2022] Open
Abstract
There is an increased demand for molecular and epidemiological information regarding Hepatitis B Virus (HBV) infection as the disease severity depends on these specifications. We have aimed to analyze nucleos(t)ide analogues (NA) resistance and typical HBsAg escape mutations with the dispersion of HBV genotype/subgenotype/HBsAg serotypes on overlapping pol/S gene regions in the Turkish population. Samples were collected in Northern Cyprus. Reverse transcriptase (rt) region between 80–250 amino acids were amplified. Typical HBsAg escape mutations were determined as HBIg escape (6.48%), vaccine escape (8.34%), HBsAg misdiagnosis (9.25%), and immune escape mutations (8.34%). NAs resistances were determined as primary (2.78%), partial (2.78%), and compensatory mutations (26.85%) in overlapping pol/S gene region. The study patients were predominantly infected with HBV genotype D/D1 (98%). However, the predominant HBsAg serotype was ayw2 (99%). The most common NA resistance mutation was rtQ215H/P/S (16.67%), however, for S gene the misdiagnosis mutations were observed most frequently (9.25%). We can conclude that HBV D/D1 is the dominant strain and ayw2 is the dominant serotype in the Turkish Cypriot. Cyprus is an island located in the Eastern Mediterranean region, and it is, therefore, a key location for human trafficking and immigration; as a result of this reputation, it is necessary to analyze HBV phylogenetically for local dynamics, and our results indicate that treatment naïve population is prone to these pol/S gene mutations. However, if HBV strains were also analyzed among Greek Cypriots too, this would enable a complete island survey. With this work, we believe that we have enlightened this subject for further research.
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Affiliation(s)
- Unal Sumer
- Near East University, Faculty of Medicine, Department of Medical Microbiology , Nicosia , Northern Cyprus
| | - Murat Sayan
- Kocaeli University, Faculty of Medicine, Clinical Laboratory, PCR Unit , Kocaeli , Turkey ; Near East University, Research Centre of Experimental Health Sciences , Nicosia , Northern Cyprus
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Arikan A, Sayan M, Sanlidag T, Suer K, Akcali S, Guvenir M. Evaluation of the pol/S Gene Overlapping Mutations in Chronic Hepatitis B Patients in Northern Cyprus. Pol J Microbiol 2019; 68:317-322. [PMID: 31880877 PMCID: PMC7256834 DOI: 10.33073/pjm-2019-034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 02/06/2023] Open
Abstract
Mutations associated with the pol and the S gene can emerge as a consequence of the high replication capacity and proofreading deficiencies of hepatitis B virus during replication. The current study was constructed to evaluate primary, partial, compensatory and the escape mutations in chronic hepatitis B patients in Northern Cyprus. The samples of HBsAg positive treatment naïve 100 patients were involved in this study. HBV pol gene region was sequenced, amplified and HBV pol/S gene mutations were determined. The samples of thirty-two patients were excluded because of their low viral load (HBV < 1000 ıu/ml). Among the sequenced 68 samples, there was a partial mutation (1.5%) and 36.7% displayed a resistance profile to lamivudine, adevofir, and telbivudine. Immune response escape, vaccine escape, HBIg and diagnosis escape mutations were determined in 24%, 10%, 6%, and 4% samples of the patients, respectively. Additionally, there were six different combined mutations. These data underscored that there is no concern for primary mutations in Northern Cyprus, however, we have identified a compensatory mutation (rtV173M) that may have primary mutation characteristics by combining with other mutation patterns. Additionally, HBsAg escape mutants demonstrated that detection of the S gene together with the pol gene mutations might be beneficial and important to monitor the surveillance of S variants.
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Affiliation(s)
- Ayse Arikan
- Near East University, Faculty of Medicine, Medical Microbiology Department , Nicosia , Northern Cyprus ; Near East University, Research Center of Experimental Health Sciences , Nicosia , Northern Cyprus
| | - Murat Sayan
- Kocaeli University, Research and Education Hospital, Clinical Laboratory , PCR Unit , Kocaeli ; Near East University, Research Center of Experimental Health Sciences , Nicosia , Northern Cyprus
| | - Tamer Sanlidag
- Near East University, Research Center of Experimental Health Sciences , Nicosia , Northern Cyprus ; Manisa Celal Bayar University, Faculty of Medicine, Medical Microbiology Department , Manisa , Turkey
| | - Kaya Suer
- Near East University, Faculty of Medicine, Infectious Disease and Clinical Microbiology Department , Nicosia , Northern Cyprus
| | - Sinem Akcali
- Manisa Celal Bayar University, Faculty of Medicine, Medical Microbiology Department , Manisa , Turkey
| | - Meryem Guvenir
- Near East University, Vocational School of Health Services, Microbiology , Nicosia , Northern Cyprus
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Özgüler M, Sayan M. Could resistant and escape variants of hepatitis B virus be a problem in the future? Future Virol 2018. [DOI: 10.2217/fvl-2017-0144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aim: Nucleos(t)ide analogs have a risk for the development of Polymerase gene mutations and they can cause compensatory mutations in the HBV surface gene. Alteration in the ‘a determinant’ of the s gene predispose for escape mutants. We aimed to evaluate primary, compensatory and escape mutations in chronic hepatitis B. Materials & methods: Two hundred nineteen specimens were obtained and HBV pol gene region was sequenced and amplified and HBV pol/s gene mutations were determined. Results: We detected primary mutation in 29.8% patients. Compensatory mutations were detected in 50.3%patients. Hepatitis B Immunoglobulin escape mutations, vaccine escape mutations, Hepatitis B diagnosis-escape and immunoselected amino acid substitutions were observed in 9.6%, 6.9%, 5.2% and 11.9% of patients, respectively. Antiviral drug-associated potential vaccine-escape mutants were detected in 17.9% patients. Conclusion: Therefore, epidemiological and demographical changes may be possible. Therefore, the typical HBsAg mutants and antiviral drug-associated potential vaccine-escape mutants should be monitored carefully.
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Affiliation(s)
- Müge Özgüler
- Department of Infectious Diseases & Clinical Microbiology, Elazığ Education & Research Hospital, Medical Sciences University, Elazığ, Turkey
| | - Murat Sayan
- PCR Unit, Faculty of Medicine, Clinical Laboratory, Kocaeli University, Kocaeli, Turkey
- Research Center of Experimental Health Sciences, Near East University, Nicosia, Northern Cyprus
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Molecular Characterization of Drug Resistance in Hepatitis B Viruses Isolated from Patients with Chronical Infection in Turkey. HEPATITIS MONTHLY 2018. [DOI: 10.5812/hepatmon.12472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Gencay M, Hübner K, Gohl P, Seffner A, Weizenegger M, Neofytos D, Batrla R, Woeste A, Kim HS, Westergaard G, Reinsch C, Brill E, Thu Thuy PT, Hoang BH, Sonderup M, Spearman CW, Pabinger S, Gautier J, Brancaccio G, Fasano M, Santantonio T, Gaeta GB, Nauck M, Kaminski WE. Ultra-deep sequencing reveals high prevalence and broad structural diversity of hepatitis B surface antigen mutations in a global population. PLoS One 2017; 12:e0172101. [PMID: 28472040 PMCID: PMC5417417 DOI: 10.1371/journal.pone.0172101] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/31/2017] [Indexed: 02/07/2023] Open
Abstract
The diversity of the hepatitis B surface antigen (HBsAg) has a significant impact on the performance of diagnostic screening tests and the clinical outcome of hepatitis B infection. Neutralizing or diagnostic antibodies against the HBsAg are directed towards its highly conserved major hydrophilic region (MHR), in particular towards its “a” determinant subdomain. Here, we explored, on a global scale, the genetic diversity of the HBsAg MHR in a large, multi-ethnic cohort of randomly selected subjects with HBV infection from four continents. A total of 1553 HBsAg positive blood samples of subjects originating from 20 different countries across Africa, America, Asia and central Europe were characterized for amino acid variation in the MHR. Using highly sensitive ultra-deep sequencing, we found 72.8% of the successfully sequenced subjects (n = 1391) demonstrated amino acid sequence variation in the HBsAg MHR. This indicates that the global variation frequency in the HBsAg MHR is threefold higher than previously reported. The majority of the amino acid mutations were found in the HBV genotypes B (28.9%) and C (25.4%). Collectively, we identified 345 distinct amino acid mutations in the MHR. Among these, we report 62 previously unknown mutations, which extends the worldwide pool of currently known HBsAg MHR mutations by 22%. Importantly, topological analysis identified the “a” determinant upstream flanking region as the structurally most diverse subdomain of the HBsAg MHR. The highest prevalence of “a” determinant region mutations was observed in subjects from Asia, followed by the African, American and European cohorts, respectively. Finally, we found that more than half (59.3%) of all HBV subjects investigated carried multiple MHR mutations. Together, this worldwide ultra-deep sequencing based genotyping study reveals that the global prevalence and structural complexity of variation in the hepatitis B surface antigen have, to date, been significantly underappreciated.
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Affiliation(s)
- Mikael Gencay
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | - Kirsten Hübner
- Bioscientia Institute for Medical Diagnostics, Ingelheim, Germany
| | - Peter Gohl
- Bioscientia Institute for Medical Diagnostics, Ingelheim, Germany
| | - Anja Seffner
- Department of Molecular Genetics and Microbiology, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
| | - Michael Weizenegger
- Department of Molecular Genetics and Microbiology, MVZ Labor Dr. Limbach & Kollegen GbR, Heidelberg, Germany
| | | | - Richard Batrla
- Roche Diagnostics International Ltd, Rotkreuz, Switzerland
| | | | - Hyon-suk Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | | | | | - Eva Brill
- Bioscientia Institute for Medical Diagnostics, Ingelheim, Germany
| | - Pham Thi Thu Thuy
- Hepatology Department, Medic Medical Center, Ho Chi Minh City, Vietnam
| | - Bui Huu Hoang
- Gastroenterology Department, Ho Chi Minh City University Medical Center, Ho Chi Minh City, Vietnam
| | - Mark Sonderup
- Division of Hepatology and Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - C. Wendy Spearman
- Division of Hepatology and Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Stephan Pabinger
- AIT Austrian Institute of Technology, Health and Environment Department, Molecular Diagnostics, Vienna, Austria
| | | | - Giuseppina Brancaccio
- Infectious Diseases and Viral Hepatitis Unit, Second University of Naples, Naples, Italy
| | - Massimo Fasano
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Teresa Santantonio
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giovanni B. Gaeta
- Infectious Diseases and Viral Hepatitis Unit, Second University of Naples, Naples, Italy
| | - Markus Nauck
- Bioscientia Institute for Medical Diagnostics, Ingelheim, Germany
- * E-mail: (WEK); (MN)
| | - Wolfgang E. Kaminski
- Bioscientia Institute for Medical Diagnostics, Ingelheim, Germany
- * E-mail: (WEK); (MN)
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Chaouch H, Taffon S, Villano U, Equestre M, Bruni R, Belhadj M, Hannachi N, Aouni M, Letaief A, Ciccaglione AR. Naturally Occurring Surface Antigen Variants of Hepatitis B Virus in Tunisian Patients. Intervirology 2016; 59:36-47. [PMID: 27544241 DOI: 10.1159/000445894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/02/2016] [Indexed: 11/19/2022] Open
Abstract
In Tunisia, the prevalence of naturally occurring surface (S) gene variants of hepatitis B virus (HBV) has not been determined. In the present study, the prevalence of these variants was examined in terms of the clinical and viral state in a series of 99 Tunisian patients with HBV infection. The S genes were amplified and directly sequenced. Genotype D was predominant (98%), 40.4% isolates belonged to subgenotypes D7 and 1 to subgenotype D2. The most common subtype was ayw2 (95.9%). In total, 60.6% of the studied strains harbored S mutations. Several novel mutation patterns were detected. Interestingly, the presence of S mutations was significantly correlated with the D7 subgenotype, low HBV DNA and advancing age (≥35 years), and tended to be higher in liver cirrhosis than in chronic infection. The global prevalence of the major hydrophilic region variants was 12.1%, with substitution S143L/T as the most frequent (4%). Only 33.9% of S substitutions produced amino acid changes in the polymerase gene. In conclusion, a high prevalence of naturally occurring HBsAg variants was observed among Tunisian HBV carriers. Natural viral variability in a geographical region and duration of infection are among the major factors associated with the occurrence of S mutations.
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Affiliation(s)
- Houda Chaouch
- Department of Infectious Diseases, Viral Hepatitis Research Unit (UR12SP35), University Hospital Farhat Hached, Sousse, Tunisia
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