title: Clinical and molecular characterization of chronic hepatitis B in Albania: a country that is still highly endemic for HBV infection.
abstract: Albania is a Mediterranean country, still with a high endemicity level of hepatitis B virus (HBV) infection. The chronic hepatitis B profile was characterized in this geographical area and used as a model to investigate the impact of endemicity level on the prevalence of the two major forms of chronic hepatitis B (HBeAg-positive and HBeAg-negative chronic hepatitis B). A cross-sectional study was conducted among 62 chronic hepatitis B patients consecutively admitted to the most important tertiary health care center for the diagnosis and treatment of liver disease in Albania. HBV-DNA was measured with an in-house PCR with a sensitivity of 10(4) copies/ml which uses primers encompassing the pre-core/core region. PCR products were subjected to sequencing and oligohybridization assay. Of the 62 patients, 75.8% had HBeAg-negative chronic hepatitis B. Genotype D was found in all 39 patients with detectable HBV viremia, for whom the heterogeneity of the region modulating HBeAg expression was assessed. Basic core promoter (BCP) mutations (1762/1764) were observed more often in anti-HBe-positive and older patients. In more than 90% of the HBeAg-negative chronic hepatitis B patients with detectable viremia, HBV that carries the G to A pre-core mutation at nucleotide 1896 was found. Patients with HBeAg-positive chronic hepatitis B were younger than HBeAg-negative chronic hepatitis B patients, and for symptomatic and asymptomatic liver-disease patients, the age of peak prevalence was at least 10 years lower for HBeAg-positive chronic hepatitis B patients. In conclusion, the virological and clinical pattern of chronic hepatitis B in Albania is similar to that observed in other Mediterranean countries; it seems to be independent of the HBV endemicity level.
authors.affiliation: Department of Infectious, Parasitic, and Immunomediated Diseases, Viral Hepatitis Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
authors.forename: L A
authors.initials: LA
authors.lastname: Kondili
authors.forename: M R
authors.initials: MR
authors.lastname: Brunetto
authors.forename: A M
authors.initials: AM
authors.lastname: Maina
authors.forename: C
authors.initials: C
authors.lastname: Argentini
authors.forename: P
authors.initials: P
authors.lastname: Chionne
authors.forename: V
authors.initials: V
authors.lastname: La Sorsa
authors.forename: B
authors.initials: B
authors.lastname: Resuli
authors.forename: A
authors.initials: A
authors.lastname: Mele
authors.forename: Maria
authors.initials: M
authors.lastname: Rapicetta
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000415:Albania / Q000453:epidemiology; D004279:DNA, Viral / Q000097:blood / Q000737:chemistry; D014644:Genetic Variation; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008875:Middle Aged; D017720:Molecular Epidemiology; D009693:Nucleic Acid Hybridization; D017354:Point Mutation / Q000235:genetics; D011401:Promoter Regions, Genetic / Q000235:genetics; D017422:Sequence Analysis, DNA; D014766:Viremia
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens