title: Hepatitis B virus genotype A is more often associated with severe liver disease in northern India than is genotype D.
abstract: BACKGROUND
  The clinical outcome of chronic hepatitis B may depend on hepatitis B virus (HBV) genotype. Data from India on this aspect are limited and contradictory. We studied the frequency of HBV genotypes and their clinical significance.
  
  
  METHODS
  Stored sera from patients with chronic HBV infection were tested for HBV genotype using PCR-RFLP. Clinical data, and biochemical and serological parameters were retrieved from medical records; patients were classified as having chronic hepatitis or cirrhosis.
  
  
  RESULTS
  Of 70 patients studied (mean age [SD] 38.4 [17.0] years; 63 men; ALT 140 [177] U/L), 32 had chronic hepatitis and 38 had cirrhosis. HBeAg was positive in 50/67 (75%), and anti-HBe in 12/66 (18%). Genotype A was the commonest (37; 53%), followed by D (32; 46%) and C (1; 1%). Patients with genotype A more often had ALT elevation exceeding 1.5 times normal (30/37 [81%] than those with genotype D (18/31 [58%]; p< 0.05). They also more often had positive HBeAg (32/37; 86%) and negative anti-HBe (33/36; 92%) than those with genotype D (18/29 [62%] and 21/29 [72%], respectively; p< 0.05 each). Of 37 patients with genotype A, 23 (62%) had cirrhosis and 14 (38%) had chronic hepatitis; of 32 patients with genotype D, 15 (47%) had cirrhosis and 17 (53%) had chronic hepatitis (p=ns). In the subgroup aged> 25 years, genotype A patients more often had cirrhosis than those with genotype D (23/28 [82%] vs 13/23 [57%]; p < 0.05).
  
  
  CONCLUSIONS
  HBV genotypes A and D were the commonest in our population. Genotype A was more often associated with ALT elevation, HBeAg positivity, absence of anti-HBe and, among those aged 25 years and above, cirrhosis of liver, than was genotype D.
authors.affiliation: Departments of Gastroenterology and Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226 014, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.forename: Sirish I
authors.initials: SI
authors.lastname: Kumar
authors.forename: Reeta
authors.initials: R
authors.lastname: Pandey
authors.forename: Sita
authors.initials: S
authors.lastname: Naik
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D004279:DNA, Viral; D005260:Female; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D012150:Polymorphism, Restriction Fragment Length; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric
chemical_list: D004279:DNA, Viral