title: Clinical, epidemiological and virological features of acute hepatitis B in Italy.
abstract: OBJECTIVE
  To evaluate the association of hepatitis B virus (HBV) genotypes, basal core promoter (BCP)/precore (PC) and S gene mutations with the clinical-epidemiological characteristics of acute hepatitis B (AHB) in Italy.
  
  
  METHODS
  During July 2005-January 2007, 103 symptomatic AHB patients were enrolled and prospectively followed up at 15 national hospitals. HBV genotypes, BCP/PC and S gene variants were determined by nested-PCR and direct sequence analysis.
  
  
  RESULTS
  Genotype D, A and F were detected in 49, 45 and 6% of patients, respectively. BCP, PC, and BCP plus PC variants were found in 3.1, 11.3 and 7.2% of patients, respectively. At enrollment, 68.3% of patients were hepatitis B e antigen (HBeAg)-positive and 31.7% HBeAg-negative. BCP/PC mutations were more common in HBeAg-negative than in HBeAg-positive patients (p < 0.0001). Compared to genotype D patients, those harboring non-D genotypes were more frequently males (p = 0.023), HBeAg-positive (p < 0.001), had higher bilirubin (p = 0.014) and viremia (p = 0.034) levels and less frequently carried BCP/PC mutations (p < 0.001). Non-D genotype patients more often were from Central Italy (p = 0.001) and reported risky sexual exposure (p = 0.021). Two patients had received vaccination before AHB: one harbored genotype F; the other showed a S gene mutation. Four patients developed fulminant AHB; mutations were found in 2 of 3 patients who underwent BCP/PC sequencing. After a 6-month follow-up, only 2 (2.8%) patients developed persistent infection.
  
  
  CONCLUSIONS
  AHB by non-D genotypes is increasing in Italy and is associated with risky sexual exposure. The ability of some genotypes to cause persistent and/or severe infection in Italy warrants larger studies for clarification.
authors.affiliation: Surveillance and Health Promotion, National Center of Epidemiology, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Ornella
authors.initials: O
authors.lastname: Zuccaro
authors.forename: Luisa
authors.initials: L
authors.lastname: Romanò
authors.forename: Alfonso
authors.initials: A
authors.lastname: Mele
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariano
authors.forename: Massimo
authors.initials: M
authors.lastname: Clementi
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Tosti
authors.forename: Gloria
authors.initials: G
authors.lastname: Taliani
authors.forename: Claudio
authors.initials: C
authors.lastname: Galli
authors.forename: Alessandro Remo
authors.initials: AR
authors.lastname: Zanetti
authors.forename: Enea
authors.initials: E
authors.lastname: Spada
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology*; D006512:Hepatitis B Core Antigens / Q000235:genetics; D017325:Hepatitis B Vaccines; D006515:Hepatitis B virus / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines