Clinical and molecular characterization of chronic hepatitis B in Albania: A country that is still highly endemic for HBV infection

Abstract

Albania is a Mediterranean country, still with a high endemicity level of hepatitis B virus (HBV) infection. The chronic hepatitis B profile was characterized in this geographical area and used as a model to investigate the impact of endemicity level on the prevalence of the two major forms of chronic hepatitis B (HBeAg-positive and HBeAg-negative chronic hepatitis B). A cross-sectional study was conducted among 62 chronic hepatitis B patients consecutively admitted to the most important tertiary health care center for the diagnosis and treatment of liver disease in Albania. HBV-DNA was measured with an in-house PCR with a sensitivity of 10(4) copies/ml which uses primers encompassing the pre-core/core region. PCR products were subjected to sequencing and oligohybridization assay. Of the 62 patients, 75.8% had HBeAg-negative chronic hepatitis B. Genotype D was found in all 39 patients with detectable HBV viremia, for whom the heterogeneity of the region modulating HBeAg expression was assessed. Basic core promoter (BCP) mutations (1762/1764) were observed more often in anti-HBe-positive and older patients. In more than 90% of the HBeAg-negative chronic hepatitis B patients with detectable viremia, HBV that carries the G to A pre-core mutation at nucleotide 1896 was found. Patients with HBeAg-positive chronic hepatitis B were younger than HBeAg-negative chronic hepatitis B patients, and for symptomatic and asymptomatic liver-disease patients, the age of peak prevalence was at least 10 years lower for HBeAg-positive chronic hepatitis B patients. In conclusion, the virological and clinical pattern of chronic hepatitis B in Albania is similar to that observed in other Mediterranean countries; it seems to be independent of the HBV endemicity level.

Hepatitis B virus genotypes and precore/core-promoter mutations in Tunisian patients with chronic hepatitis B virus infection

“…It has been found to be a more predominant genotype in the south and in oriental regions of the Mediterranean area 22,25,26,34 than in southeastern Europe, where genotype A is commonly found. 16,28,35,36 Infection with genotype D was also detected in significantly higher proportion in subjects from India 33,37 and Siberia. 32 In many countries where well-known waves of migration have occurred over time, the prevalence of genotype D reflects the origin of the immigrants and other patterns of migration.…”

“…As for the response to antiviral treatment, genotypes C and D respond less to interferon therapy than genotypes B and A. 35 Study of the viral genotype in chronic HBV infection may be valuable in predicting the persistence of viral replication after seroconversion to anti-HBeAg, and suggest that the outcome of chronic infection may be affected by HBV variability. Thus heterogeneity of disease manifestations and response to antiviral treatment among patients with chronic HBV in different parts of the world may, at least partly, be attributed to differences in HBV genotypes.…”

Hepatitis B Virus Infection in Health Care Workers in Albania: a Country still Highly Endemic for HBV Infection

“…In the view of the existence of HBV e-minus mutants in Albania, as in other Mediterranean countries, HBeAg negativity of a given health care worker does not exclude high HBV DNA levels and probably infectivity of his serum [2,12].…”

Epidemiology of HBV subgenotypes D

“…It is a common genotype in southern Europe, North Africa, India, China, and West and South Africa [76,77]. Genotype D makes up around 100% of the HBV cases in countries, including Greece [78], Italy [79], Serbia [44,45], Albania [41,80], Turkey [46][47][48][49][50][51], Lebanon [36] and Iran [27][28][29][30][31][32][33][34].…”