Abstract
BackgroundGenotyping of HBV is generally used for determining the epidemiological relationship between various virus strains and origin of infection mostly in research studies. The utility of genotyping for clinical applications is only beginning to gain importance. Whether HBV genotyping will constitute part of the clinical evaluation of Hepatitis B patients depends largely on the availability of the relevance of the evidence based information. Since Pakistan has a HBV genotype distribution which has been considered less virulent as investigated by earlier studies from south East Asian countries, a study on correlation between HBV genotypes and risk of progression to further complex hepatic infection was much neededMethodsA total of 295 patients with HBsAg positive were selected from the Pakistan Medical Research Council's (PMRC) out patient clinics. Two hundred and twenty six (77%) were males, sixty nine (23%) were females (M to F ratio 3.3:1).ResultsOut of 295 patients, 156 (53.2%) had Acute(CAH), 71 (24.2%) were HBV Carriers, 54 (18.4%) had Chronic liver disease (CLD) Hepatitis. 14 (4.7%) were Cirrhosis and HCC patients. Genotype D was the most prevalent genotype in all categories of HBV patients, Acute (108), Chronic (39), and Carrier (53).Cirrhosis/HCC (7) were HBV/D positive. Genotype A was the second most prevalent with 28 (13%) in acute cases, 12 (22.2%) in chronics, 14 (19.7%) in carriers and 5 (41.7) in Cirrhosis/HCC patients. Mixed genotype (A/D) was found in 20 (12.8%) of Acute patients, 3 (5.6%) of Chronic and 4 (5.6%) of carriers, none in case of severe liver conditions.ConclusionMixed HBV genotypes A, D and A/D combination were present in all categories of patients except that no A/D combination was detected in severe conditions. Genotype D was the dominant genotype. However, genotype A was found to be more strongly associated with severe liver disease. Mixed genotype (A/D) did not significantly appear to influence the clinical outcome.
Highlights
Genotyping of HBV is generally used for determining the epidemiological relationship between various virus strains and origin of infection mostly in research studies
Mixed HBV genotypes A, D and A/D combination were present in all categories of patients except that no A/D combination was detected in severe conditions
Genotype A was found to be more strongly associated with severe liver disease
Summary
Genotyping of HBV is generally used for determining the epidemiological relationship between various virus strains and origin of infection mostly in research studies. HBV is a classical virus that has amazed the researchers and clinicians around the world first with geographic relationship of its genotypes secondly the association of its different genotypes with a wide spectrum of clinical manifestations. 2 billion people in the world are infected by HBV [2], More than 350 million people are chronic carriers of the virus [3] Acute hepatitis of varying severity exists in 95% of children and 2–10 % of adult patients [4]. Fifteen to 40% of chronically infected people may develop cirrhosis and HCC, the remaining individuals become asymptomatic carriers. There is a strong chance for the child to become chronically infected compared to the infection acquired during adulthood,(about 10% to 20%) [7,8]
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