title: Precore and basal core promoter mutations in Asian American patients with hepatitis B e antigen-positive chronic hepatitis B.
abstract: BACKGROUND
  Prior studies have shown that precore mutations abolish and basal core promoter (BCP) mutations down-regulate hepatitis B e antigen (HBeAg) production. Thus, the presence of precore and BCP mutations in HBeAg-positive patients indicates an infection with a mixed viral population of wild-type and precore and/or BCP mutant hepatitis B virus (HBV). To date, there has been limited study of the prevalence and clinical significance of precore and BCP mutations in patients with HBeAg-positive chronic hepatitis B.
  
  
  OBJECTIVE
  To determine the prevalence, predictors and clinical characteristics of mixed wild-type and precore/BCP HBV infection, through a cross-sectional study, in a US cohort of patients with chronic hepatitis B.
  
  
  METHODS
  We conducted a retrospective study of 828 chronic hepatitis B patients with HBV genotype and mutation panel testing seen at three US gastroenterology and liver clinics from June 2005 to September 2009.
  
  
  RESULTS
  A majority of our patients (92.3%) were either Vietnamese or Chinese American. In the HBeAg-positive cohort, 17% of patients had precore mutations only, 28% had BCP mutations only and 5% had both BCP and precore mutations. On multivariate analyses, HBV genotype C, increasing age, lower HBV DNA level and an ALT quotient >2 were independent predictors for the presence of precore and/or BCP mutations.
  
  
  CONCLUSIONS
  The current distinction and management recommendations for HBeAg-positive vs. HBeAg-negative patients with chronic hepatitis B should be reassessed. Additional biomarkers and treatment endpoints should be studied for their usefulness in predicting continued viral suppression after treatment discontinuation.
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: P
authors.initials: P
authors.lastname: Vutien
authors.forename: H N
authors.initials: HN
authors.lastname: Trinh
authors.forename: K
authors.initials: K
authors.lastname: Nguyen
authors.forename: R T
authors.initials: RT
authors.lastname: Garcia
authors.forename: H A
authors.initials: HA
authors.lastname: Nguyen
authors.forename: B S
authors.initials: BS
authors.lastname: Levitt
authors.forename: L
authors.initials: L
authors.lastname: Nguyen
authors.forename: N B
authors.initials: NB
authors.lastname: Ha
authors.forename: A
authors.initials: A
authors.lastname: Ahmed
authors.forename: T
authors.initials: T
authors.lastname: Daugherty
authors.forename: G
authors.initials: G
authors.lastname: Garcia
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000235:genetics; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D006513:Hepatitis B e Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics* / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009154:Mutation; D011401:Promoter Regions, Genetic / Q000235:genetics*; D012189:Retrospective Studies; D014481:United States; D019562:Viral Load; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens