title: Cocirculation of and coinfections with hepatitis A virus subgenotypes IIIA and IB in patients from Pune, western India.
abstract: OBJECTIVE
  During the 1990s, a changing pattern of epidemiology of hepatitis A was reported in different populations of India. The present study was undertaken to investigate the molecular epidemiology of hepatitis A virus (HAV) strains over a period of 10 years.
  
  
  METHODS
  Stool/serum samples were collected from hepatitis A patients clinically presenting acute viral hepatitis and hepatic encephalopathy. Reverse transcriptase polymerase chain reaction (RT-PCR) was performed to detect HAV-RNA. HAV genomes were examined by sequencing PCR products of VP1/2A junction (168 bp) and RNA polymerase (116 bp) regions.
  
  
  RESULTS
  Subgenotype IIIA and IB were detected in 74.2% and 9.7% of specimens, respectively, while 16.1% of patients had mixed infections. Sewage samples also showed presence of both IIIA (9/10) and IB (1/10) subgenotypes. RNA polymerase region showed two clusters constituting 51.6% and 19.4% strains closer to Nor21 and HM175 strains, respectively, in clinical specimens. Three isolates appeared as discordant subgenotypes in VP1/2A and RNA polymerase regions.
  
  
  CONCLUSIONS
  The data revealed cocirculation of and coinfection with subgenotypes IIIA and IB, with predominance of IIIA and genetic heterogeneity of HAV strains in western India.
authors.affiliation: Rotavirus Department, National Institute of Virology, Pune, India.
authors.forename: Shobha
authors.initials: S
authors.lastname: Chitambar
authors.forename: Madhuri
authors.initials: M
authors.lastname: Joshi
authors.forename: Kavita
authors.initials: K
authors.lastname: Lole
authors.forename: Atul
authors.initials: A
authors.lastname: Walimbe
authors.forename: Sunil
authors.initials: S
authors.lastname: Vaidya