Persistence of acute infection with hepatitis B virus genotype A and treatment in Japan

Abstract

Among the 97 adult patients with acute hepatitis B who were admitted to the Toranomon Hospital in Metropolitan Tokyo during 28 years from 1976 to 2003, 31 (32%) were infected with hepatitis B virus (HBV) genotype A, nine (9%) with genotype B, 44 (45%) with genotype C, one (1%) each with genotypes E and F. HBV in the remaining 11 (11%) patients were untypeable. All the 31 patients with acute hepatitis B caused by HBV genotype A infection were male with a median age of 31 years, and 16 (52%) contracted infection through extramarital sexual contacts. The baseline HBV DNA level was higher in the seven (23%) patients in whom infection with HBV genotype A persisted than the remaining 24 (77%) with spontaneous resolution (median: >8.7 vs. 6.0 log genome equivalents/ml, P = 0.004). Persistent infection was more frequent in patients with maximum alanine aminotransferase <500 IU/L than > or =500 IU/L (83% [5/6] vs. 4% [1/25], P = 0.0001). Of the six patients with persistent HBV genotype A infection who received interferon and/or lamivuidine for treatment of chronic active hepatitis, three (50%) responded with the loss of hepatitis B e antigen (HBeAg); hepatitis B surface antigen (HBsAg) was cleared from serum in one patient who received interferon and lamivudine in sequence. HBV genotype A persisted along with HBeAg in the remaining three patients given antiviral therapy as well as another who was not treated. In conclusion, infection with HBV genotype A prevails in patients with acute hepatitis B in Japan where genotypes B and C are common, is often contracted sexually (16/31 [52%]) and tends to persist (7/31 [23%]). Infection was cleared in only one of the six (17%) patients who received antiviral therapy.

Diagnosis of hepatitis B

“…Evidences increasingly suggest that the HBV genotyping is significant to predict HBV disease progression and determine appropriate antiviral therapy. Acute infection with genotypes A and D leads to higher rate of chronicity than genotypes B and C (28)(29)(30). Genotype C generally is considered as a risk factor for perinatal infection (31) and related to severe liver disease, including cirrhosis and HCC (32)(33)(34).…”

Identification of Novel Recombinant Forms of Hepatitis B Virus Generated from Genotypes Ae and G in HIV-1-Positive Japanese Men Who Have Sex with Men

“…The genotypes of HBV show a distinct geographic distribution 10,11 and are associated with different clinical outcomes, responses to treatment with interferon or nucleotide analogues, and rates of fulminant hepatitis. [12][13][14][15][16][17][18][19][20][21] Historically, 96.9% of HBV isolates from Japanese individuals with chronic hepatitis B belong to genotypes B or C 14 ; however, since 2000, HBV/A has spread in urban areas through homosexual intercourse. 18,[21][22][23] The positivity rate for HBV infection in Japanese HIV-1-infected individuals is 8.9%, and half of HBV-infected individuals harbor the genotype A virus.…”

Virological outcomes in patients infected chronically with hepatitis B virus genotype A in comparison with genotypes B and C

“…During 31 years, 128 patients with genotype A visited there. Unlike most infections with genotype B and C transmitted perinatally from carrier mothers with HBeAg [Okada et al, 1976], genotype A infection in Japan is often acquired in the adulthood by men having extramarital sexual contacts either with men or women; there has been no evidence for maternal transmission of HBV genotype A in Japan [Kobayashi et al, 2002Ogawa et al, 2002;Suzuki et al, 2005]. HBV infection prevails among homosexuals in Western countries where genotype A is frequent, who poorly respond to vaccines [Goilav and Piot, 1989].…”

“…HBV infection prevails among homosexuals in Western countries where genotype A is frequent, who poorly respond to vaccines [Goilav and Piot, 1989]. Genotype A infection in Japan has a propensity to become chronic and tends to respond to antiviral therapies better than genotype B or C infection [Kobayashi et al, 2002, 2003Suzuki et al, 2005.…”