Molecular epidemiology of hepatitis B virus genotypes circulating in acute hepatitis B patients in the Campania region

Abstract

Fifty-three HBV-DNA-positive patients with symptomatic acute hepatitis B were enrolled from 1999 to 2010 to evaluate molecular and phylogenetic changes in HBV in southern Italy. HBV polymerase region was evaluated by direct sequencing in plasma samples obtained at first observation. Different data sets were aligned and a phylogenetic tree was inferred using PhyML program. Statistical robustness was confirmed with a bootstrap analysis. A Bayesian Markov chain Monte Carlo method and a Bayesian skyline plot were used to estimate the evolution of our samples. The dN/dS rate (ω) was estimated by the maximum likelihood approach to investigate the presence of codons under positive selection. The MacClade program was used to test viral gene out/in flow only among HBV-D3 subgenotype patients with different risk factors. Of the 53 patients, 83% were born in Italy and 17% were foreigners. HBV genotype D was prevalent (64.1%), followed by genotype A (26.4%), E (3.8%), and F (5.7%). The prevalent subgenotype was D3 (70.6%). The Bayesian tree of the 24 D3 subgenotypes showed two main clades both dated 1994; 40% of viral gene flow observed was from intravenous drugs users and heterosexual patients. Phylogenetic analysis of HBV isolates showed that HBV-D3 remains the prevalent genotype, but also subgenotype A2 has become frequent in southern Italy. This may be of clinical relevance in years to come, since patients with HBV-genotype-A chronic infection less frequently than those with genotype D develop HBeAg-negative chronic hepatitis and respond more frequently to alfa-interferon treatment.

Clinical, epidemiological and virological features of acute hepatitis B in Italy

“…A major finding of our study is that more than half (51 %) of the observed AHB cases were due to non-D genotypes, mainly genotype A and F. Genotype A is prevalent in North Europe, the USA, Sub-Saharan and Western Africa [10,11], while genotype F is common in Central and South America, although it has already been observed in Italy [10,11,14,17,19,24]. The prevalence of genotype A (45 %) we found in our study was considerably higher than that reported in the same range time by Coppola et al (13.7 %) [17] and by Scalia et al (27 %) [18].…”

“…Thus, looking at our and other available data [17][18][19][20]24], it seems that in Italy the frequency of AHB cases due to genotype A has increased over time, while AHB cases harboring other non-D genotypes have been detected only sporadically. This scenario is consistent with the results obtained in a large sample of CHB patients in North-Eastern Italy during the years 2002-2004; among these patients the prevalence of genotype D and A was 70.6 and 25 %, respectively, while other unusual genotypes (C, E, F, H) were detected in very low percentages, mainly in foreigners [14].…”

Molecular diversity in irregular or refugee immigrant patients with HBV‐genotype‐E infection living in the metropolitan area of Naples

“…Cluster A dated back to (95% HPD:1997; cluster B dated back to (95% HPD:2001; cluster C to 2006(95% HPD:1999cluster D to 2004cluster D to (95% HPD:1998cluster D to -2011. This study disclosed the INTRODUCTION HBV genotypes have a characteristic ethno-geographical distribution: genotype A predominates in north-western Europe, North America, and Central Africa [Norder et al, 2004], genotype D in the Mediterranean area [Sagnelli E et al, 2005;2012a,b;2014a,b;Zehender et al, 2008;Coppola et al, 2010Coppola et al, , 2014Sagnelli C et al, 2014;, the Middle-east, and southern Asia [Norder et al, 2004;Amini-Bavil-Olyaee et al, 2005], genotypes B and C in Asia [Okamoto et al, 1988], genotype E in sub-Saharan Africa [Norder et al, 1994[Norder et al, , 2004, the United Kingdom, France, and Saudi Arabia [Zehender et al, 2008, and genotype F in South and Central America [Norder et al, 2004]. In addition, genotype G has been found in France and the United States [Okamoto et al, 1988], genotype H is confined to the northern part of Latin America [Arauz-Ruiz et al, 2002] and genotypes I and J have been found mainly in eastern Asia .…”

Hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection in undocumented migrants and refugees in southern Italy, January 2012 to June 2013

“…These tertiary units offer refugees and undocumented migrants with serum markers of HBV, HCV or HIV infection the same clinical management given to legal migrants and to Italian citizens. These two tertiary units of infectious diseases are both affiliated with the Second University of Naples and have cooperated for nearly 15 years in several clinical investigations on HIV, HBV and HCV infections using the same clinical approach and the same laboratory methods [14][15][16][17][18].…”