Hepatitis B virus genotype G: Prevalence and impact in patients co‐infected with human immunodeficiency virus

Abstract

Relatively little is known about the role of hepatitis B virus (HBV) genotype G (HBV/G) in patients co-infected with human immunodeficiency virus (HIV) and HBV. This study examined the prevalence and association of HBV/G to liver fibrosis in co-infected patients. HBV genotypes were determined by direct sequencing of the HBV surface gene or Trugene® HBV 1.0 assay in 133 patients infected with HIV/HBV. Quantitative testing of HBV-DNA, HBeAg, and anti-HBe were performed using the Versant® HBV 3.0 (for DNA) and the ADVIA®Centaur assay. The non-invasive biomarkers Fib-4 and APRI were used to assess fibrosis stage. Genotype A was present in 103/133 (77%) of the cohort, genotype G in 18/133 (14%) with genotypes D in 8/133, (6%), F 2/133 (1.5%), and H 2/133 (1.5%). Genotype G was associated with hepatitis B e antigen-positivity and high HBV-DNA levels. Additionally, HBV/G (OR 8.25, 95% CI 2.3-29.6, P = 0.0012) was associated with advanced fibrosis score using Fib-4, whereas, being black was not (OR 0.19, 95% CI 0.05-0.07, P = 0.01). HBV/G in this population exhibited a different phenotype than expected for pure G genotypes raising the question of recombination or mixed infections. The frequent finding of HBV/G in co-infected patients and its association with more advanced fibrosis, suggests that this genotype leads to more rapid liver disease progression. Further studies are needed to understand why this genotype occurs more frequently and what impact it has on liver disease progression in patients with HBV/HIV.

High prevalence of hepatitis B virus dual infection with genotypes A and G in HIV-1 infected men in Amsterdam, the Netherlands, during 2000-2011

“…All 10 HBV-G infections concerned men that were also infected with HIV-1. Studies from other countries report a similar association of HBV-G infection with HIV-infection and with the MSM risk group [22,25,26,30,31]. In our study, only four HBV-A/G infected patients could be positively identified as MSM, for five others the risk factor was not stated.…”

“…HBV-G strains isolated worldwide show very little genetic variation compared to other HBV genotypes [10]. There are indications that mixed HBV infections that include an HBV-G strain are associated with increased liver fibrosis [27,28,30], suggesting that patients infected with HBV-G should be monitored more closely. Also, response to antiviral treatment has been reported to be less effective in patients co-infected with HBV-G as compared to single genotype infections [23].…”

Is There Any Value to Hepatitis B Virus Genotype Analysis?

“…Studies have suggested that HBV genotype G may require HBV co-infection with another genotype. The presence of infection with HBV genotype G found to be an independent risk factor for fibrosis progression in a French study of patients diagnosed with HBV and HIV coinfection [75,76]. The frequent finding of HBV G in co-infected patients and its association with more advanced fibrosis, suggests that this genotype leads to more rapid liver disease progression.…”

Hepatitis B and E Co-Primary Infections in an HIV-1-Infected Patient

“…Here, the patient reported sexual intercourse with several men and concurrently acquired HBV as well as HAV and HIV earlier in his life. Of note, he became infected with HBV genotype G, which is rare in France and worldwide but has been described to be more frequent in HIV-infected patients (34)(35)(36) and particularly among MSM (37)(38)(39). Also, we searched for top hits in the NCBI sequence database with the HAV sequence recovered from a patient's serum collected 1 year before HEV-HBV primary infection, and we found three HAV sequences with 100% nucleotide identity that were obtained from serum samples of MSM in Barcelona, Spain (40).…”