title: Impact of the hepatitis B virus genotype and genotype mixtures on the course of liver disease in Vietnam.
abstract: Eight genotypes (A-H) of hepatitis B virus (HBV) have been identified. However, the impact of different genotypes on the clinical course of hepatitis B infection remains controversial. We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam, Europe, and Africa. In addition, we analyzed the effects of genotype mixtures on alterations in in vitro viral replication. In Asian patients, seven genotypes (A-G) were detected, with A, C, and D predominating. In European and African patients, only genotypes A, C, D, and G were identified. Genotype mixtures were more frequently encountered in African than in Asian (P = .01) and European patients (P = .06). In Asian patients, the predominant genotype mixtures included A/C and C/D, compared to C/D in European and A/D in African patients. Genotype A was more frequent in asymptomatic compared with symptomatic patients (P < .0001). Genotype C was more frequent in patients with hepatocellular carcinoma (HCC; P = .02). Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B (P = .015), liver cirrhosis (P = .013), and HCC (P = .002). Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype (P = .019). Genotype mixtures were also associated with increased in vitro HBV replication. In conclusion, infection with mixtures of HBV genotypes is frequent in Asia, Africa, and Europe. Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome.
authors.affiliation: Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, Germany.
authors.forename: Nguyen L
authors.initials: NL
authors.lastname: Toan
authors.forename: Le H
authors.initials: le H
authors.lastname: Song
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.forename: Dinh N
authors.initials: DN
authors.lastname: Duy
authors.forename: Vu Q
authors.initials: VQ
authors.lastname: Binh
authors.forename: Bernd
authors.initials: B
authors.lastname: Koeberlein
authors.forename: Stefan
authors.initials: S
authors.lastname: Kaiser
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.forename: Joseph
authors.initials: J
authors.lastname: Torresi
authors.forename: C-Thomas
authors.initials: CT
authors.lastname: Bock
mesh_terms: D000328:Adult; D001208:Asia; D001483:Base Sequence; D016022:Case-Control Studies; D015331:Cohort Studies; D018450:Disease Progression; D005060:Europe; D005260:Female; D015967:Gene Expression Regulation, Viral; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D005828:Genetics, Population; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000453:epidemiology / Q000235:genetics* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000235:genetics* / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D011336:Probability; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014744:Vietnam / Q000453:epidemiology