title: Molecular characterization of hepatitis B virus in liver disease patients and asymptomatic carriers of the virus in Sudan.
abstract: BACKGROUND
  Hepatitis B virus is hyperendemic in Sudan. Our aim was to molecularly characterize hepatitis B virus from Sudanese individuals, with and without liver disease, because genotypes play an important role in clinical manifestation and treatment management.
  
  
  METHODS
  Ninety-nine patients - 30 asymptomatic, 42 cirrhotic, 15 with hepatocellular carcinoma, 7 with acute hepatitis and 5 with chronic hepatitis- were enrolled. Sequencing of surface and basic core promoter/precore regions and complete genome were performed.
  
  
  RESULTS
  The mean ± standard deviation, age was 45.7±14.8 years and the male to female ratio 77:22. The median (interquartile range) of hepatitis B virus DNA and alanine aminotransferase levels were 2.8 (2.2-4.2) log IU/ml and 30 (19-49) IU/L, respectively. Using three genotyping methods, 81/99 (82%) could be genotyped. Forty eight percent of the 99 patients were infected with genotype D and 24% with genotype E, 2% with putative D/E recombinants and 7% with genotype A. Patients infected with genotype E had higher frequency of hepatitis B e antigen-positivity and higher viral loads compared to patients infected with genotype D. Basic core promoter/precore region mutations, including the G1896A in 37% of HBeAg-negative individuals, could account for hepatitis B e antigen-negativity. Pre-S deletion mutants were found in genotypes D and E. Three isolates had the vaccine escape mutant sM133T.
  
  
  CONCLUSIONS
  Sudanese hepatitis B virus carriers were mainly infected with genotypes D or E, with patients infected with genotype E having higher HBeAg-positivity and higher viral loads. This is the first study to molecularly characterize hepatitis B virus from liver disease patients in Sudan.
authors.affiliation: Hepatitis Virus Diversity Research Programme, Department of Internal Medicine, Faculty of Health Sciences, University of Witwatersrand, Parktown, Johannesburg 2193, South Africa.
authors.forename: Mukhlid
authors.initials: M
authors.lastname: Yousif
authors.forename: Hatim
authors.initials: H
authors.lastname: Mudawi
authors.forename: Sahar
authors.initials: S
authors.lastname: Bakhiet
authors.forename: Dieter
authors.initials: D
authors.lastname: Glebe
authors.forename: Anna
authors.initials: A
authors.lastname: Kramvis
mesh_terms: D000328:Adult; D000368:Aged; D058345:Asymptomatic Infections / Q000453:epidemiology; D001483:Base Sequence; D002353:Carrier State / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005260:Female; D016679:Genome, Viral; D005838:Genotype; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification; D019694:Hepatitis B, Chronic / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D008113:Liver Neoplasms / Q000097:blood / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation; D010802:Phylogeny; D013397:Sudan / Q000453:epidemiology
chemical_list: D004279:DNA, Viral