Impact of the hepatitis B virus genotype and genotype mixtures on the course of liver disease in Vietnam

Authors

  • Nguyen L. Toan,

    1. Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, Germany
    2. Department of Parasitology, Institute of Tropical Medicine, University of Tuebingen, Germany
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    • The authors N.L. Toan and L.H. Song and J. Torresi. and C.T. Bock contributed equally to this work. N.L. Toan and L.H. Song share first authorship; J. Torresi and C.T. Bock share last authorship.

  • Le H. Song,

    1. Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, Germany
    2. Tran Hung Dao Hospital, Hanoi, Vietnam
    3. Department of Parasitology, Institute of Tropical Medicine, University of Tuebingen, Germany
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    • The authors N.L. Toan and L.H. Song and J. Torresi. and C.T. Bock contributed equally to this work. N.L. Toan and L.H. Song share first authorship; J. Torresi and C.T. Bock share last authorship.

  • Peter G. Kremsner,

    1. Department of Parasitology, Institute of Tropical Medicine, University of Tuebingen, Germany
    2. Medical Research Unit, Albert Schweitzer Hospital, Lambarene, Gabon
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  • Dinh N. Duy,

    1. Tran Hung Dao Hospital, Hanoi, Vietnam
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  • Vu Q. Binh,

    1. Institute of Prevention Medicine, Truong Dinh, Dong Da, Hanoi, Vietnam
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  • Bernd Koeberlein,

    1. Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, Germany
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  • Stefan Kaiser,

    1. Department of Internal Medicine I, University Hospital of Tuebingen, Germany
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  • Reinhard Kandolf,

    1. Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, Germany
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  • Joseph Torresi,

    1. Department of Medicine, Victorian Infectious Diseases Service, Clinical Centre for Research Excellence, Royal Melbourne Hospital, The University of Melbourne, Australia
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    • The authors N.L. Toan and L.H. Song and J. Torresi. and C.T. Bock contributed equally to this work. N.L. Toan and L.H. Song share first authorship; J. Torresi and C.T. Bock share last authorship.

  • C.-Thomas Bock

    Corresponding author
    1. Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, Germany
    • Department of Molecular Pathology, Institute of Pathology, University Hospital of Tuebingen, D-72076 Tuebingen, Germany
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    • The authors N.L. Toan and L.H. Song and J. Torresi. and C.T. Bock contributed equally to this work. N.L. Toan and L.H. Song share first authorship; J. Torresi and C.T. Bock share last authorship.

    • fax: (49) 7071-29-5334


  • Potential conflict of interest: Nothing to report.

Abstract

Eight genotypes (A-H) of hepatitis B virus (HBV) have been identified. However, the impact of different genotypes on the clinical course of hepatitis B infection remains controversial. We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam, Europe, and Africa. In addition, we analyzed the effects of genotype mixtures on alterations in in vitro viral replication. In Asian patients, seven genotypes (A-G) were detected, with A, C, and D predominating. In European and African patients, only genotypes A, C, D, and G were identified. Genotype mixtures were more frequently encountered in African than in Asian (P = .01) and European patients (P = .06). In Asian patients, the predominant genotype mixtures included A/C and C/D, compared to C/D in European and A/D in African patients. Genotype A was more frequent in asymptomatic compared with symptomatic patients (P < .0001). Genotype C was more frequent in patients with hepatocellular carcinoma (HCC; P = .02). Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B (P = .015), liver cirrhosis (P = .013), and HCC (P = .002). Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype (P = .019). Genotype mixtures were also associated with increased in vitro HBV replication. In conclusion, infection with mixtures of HBV genotypes is frequent in Asia, Africa, and Europe. Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome. (HEPATOLOGY 2006;43:1375–1384.)

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