Abstract
BackgroundHepatitis B virus is hyperendemic in Sudan. Our aim was to molecularly characterize hepatitis B virus from Sudanese individuals, with and without liver disease, because genotypes play an important role in clinical manifestation and treatment management.MethodsNinety-nine patients - 30 asymptomatic, 42 cirrhotic, 15 with hepatocellular carcinoma, 7 with acute hepatitis and 5 with chronic hepatitis- were enrolled. Sequencing of surface and basic core promoter/precore regions and complete genome were performed.ResultsThe mean ± standard deviation, age was 45.7±14.8 years and the male to female ratio 77:22. The median (interquartile range) of hepatitis B virus DNA and alanine aminotransferase levels were 2.8 (2.2-4.2) log IU/ml and 30 (19–49) IU/L, respectively. Using three genotyping methods, 81/99 (82%) could be genotyped. Forty eight percent of the 99 patients were infected with genotype D and 24% with genotype E, 2% with putative D/E recombinants and 7% with genotype A. Patients infected with genotype E had higher frequency of hepatitis B e antigen-positivity and higher viral loads compared to patients infected with genotype D. Basic core promoter/precore region mutations, including the G1896A in 37% of HBeAg-negative individuals, could account for hepatitis B e antigen-negativity. Pre-S deletion mutants were found in genotypes D and E. Three isolates had the vaccine escape mutant sM133T.ConclusionSudanese hepatitis B virus carriers were mainly infected with genotypes D or E, with patients infected with genotype E having higher HBeAg-positivity and higher viral loads. This is the first study to molecularly characterize hepatitis B virus from liver disease patients in Sudan.
Highlights
Hepatitis B virus is hyperendemic in Sudan
Hepatitis B virus (HBV) infection occurs in early childhood in southern Sudan, with the infection increasing with age in northern Sudan [3,6]
Clinical and demographic characteristics The 99 cases were classified into five clinical groups: hepatocellular carcinoma (HCC) (n=15), CR ( n=42), Asymptomatic carriers (ASC) (n=30), Acute hepatitis (AH) ( n=7) and chronic hepatitis (CH) ( n=5)
Summary
Our aim was to molecularly characterize hepatitis B virus from Sudanese individuals, with and without liver disease, because genotypes play an important role in clinical manifestation and treatment management. Sudan is an African country with high HBV seroprevalence of greater than 8% HBsAg-positivity, ranging from 6.8% in central Sudan to 26% in southern Sudan [3,4,5]. Considering Sudan’s unique position and the flux of people across its borders, it is important that the HBV genotypes prevailing in this country are determined. Knowledge of the genotypes prevailing in Sudanese, with and without liver disease, is important in treatment management, as well as disease prognosis because genotypes play a role in both of these aspects [18,19]
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