title: Hepatitis B genotypes: relation to clinical outcome in patients with chronic hepatitis B in Saudi Arabia.
abstract: OBJECTIVE
  To identify the most common hepatitis B virus (HBV) genotype in Saudi Arabia, and correlate the prevailing genotypes with the clinical outcome of patients.
  
  
  METHODS
  Patients were consecutively recruited from the hepatology clinics of two tertiary care referral centers. Patients were categorized into 4 different groups: group 1, patients with hepatitis B and normal liver enzymes; group 2, patients with hepatitis B and abnormal liver enzymes but without cirrhosis; group 3, patients with hepatitis B and liver cirrhosis; group 4, patients with hepatitis B and hepatocellular carcinoma. All patients had a positive hepatitis B surface antigen (HBsAg). Genotyping of HBV was performed by nested PCR-mediated amplification of the target sequence and hybridization with sequence-specific oligonucleotides.
  
  
  RESULTS
  Seventy patients were enrolled in this study. They were predominantly male (72.9%) in their mid-forty's (mean age 47 years). Forty-nine (70%) patients were hepatitis B envelope antigen (HBeAg) negative. The majority of patients (64%) acquired HBV through unknown risk factors. Hepatitis B genotyping revealed that 57 patients (81.4%) were genotype D, 1 patient (1.4%) had genotype A, 1 patient (1.4%) had genotype C, and 4 patients (5.7%) had genotype E, while 7 patients (10%) had mixed genotype (4 patients ADG, 1 patient DE, 1 patient DF, and 1 patient ADFG). Based on univariate analysis of genotype D patients, significant predictors of advanced liver disease were age, gender, aspartate transaminase, alanine transaminase, albumin, bilirubin, and alkaline phosphatase (all P < 0.001). In multivariate analysis decreased hemoglobin (r = -0.05; 95% CI: -0.08 to -0.03; P = 0.001) and albumin levels (r = -0.004; 95% CI: -0.007 to -0.001; P = 0.002) were highly significant predictors of advanced liver disease. In patients with HBV genotype D, HBeAg negativity was found to increase across advancing stages of liver disease (P = 0.024).
  
  
  CONCLUSIONS
  This study highlights that the vast majority of Saudi patients with chronic hepatitis B have genotype D. No correlation could be observed between the different genotypes and epidemiological or clinical factors. The relationship between genotype D and HBeAg status in terms of disease severity needs to be further elucidated in larger longitudinal studies.
authors.affiliation: Gastroenterology Divison, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia. abdoayman@hotmail.com
authors.forename: Ayman A
authors.initials: AA
authors.lastname: Abdo
authors.forename: Badr M
authors.initials: BM
authors.lastname: Al-Jarallah
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Sanai
authors.forename: Ahmad S
authors.initials: AS
authors.lastname: Hersi
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Swat
authors.forename: Nahla A
authors.initials: NA
authors.lastname: Azzam
authors.forename: Manal
authors.initials: M
authors.lastname: Al-Dukhayil
authors.forename: Amira
authors.initials: A
authors.lastname: Al-Maarik
authors.forename: Faleh Z
authors.initials: FZ
authors.lastname: Al-Faleh
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004279:DNA, Viral / Q000235:genetics*; D018450:Disease Progression; D005260:Female; D005838:Genotype; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000235:genetics* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D004279:DNA, Viral; D017325:Hepatitis B Vaccines