Hepatitis B virus strains of subgenotype A2 with an identical sequence spreading rapidly from the capital region to all over Japan in patients with acute hepatitis B

ObjectiveTo examine recent trends of acute infection with hepatitis B virus (HBV) in Japan by nationwide surveillance and phylogenetic analyses.MethodsDuring 1991 through 2009, a sentinel surveillance was conducted in 28 national hospitals in a prospective cohort study. Genotypes of HBV were determined in 547 patients with acute hepatitis B. Nucleotide sequences in the preS1/S2/S gene of genotype A and B isolates were determined for phylogenetic analyses.ResultsHBV genotype A was detected in 137 (25% (accompanied by genotype G in one)) patients, B in 48 (9%), C in 359 (66%), and other genotypes in the remaining three (0.5%). HBV persisted in five with genotype A including the one accompanied by genotype G; another was co-infected with HIV type 1. The genotype was A in 4.8% of patients during 1991-1996, 29.3% during 1997-2002, and 50.0% during 2003-2008 in the capital region, as against 6.5%, 8.5% and 33.1%, respectively, in other regions. Of the 114 genotype A isolates, 13 (11.4%) were subgenotype A1, and 101 (88.6%) were A2, whereas of the 43 genotype B isolates, 10 (23.3%) were subgenotype B1, 28 (65.1%) were B2, two (4.7%) were B3, and three (7.0%) were B4. Sequences of 65 (64%) isolates of A2 were identical, as were three (23%) of A1, and five (18%) of B2, but none of the B1, B3 and B4 isolates shared a sequence.ConclusionsAcute infection with HBV of genotype A, subgenotype A2 in particular, appear to be increasing, mainly through sexual contact, and spreading from the capital region to other regions in Japan nationwide. Infection persisted in 4% of the patients with genotype A, and HBV strains with an identical sequence prevailed in subgenotype A2 infections. This study indicates the need for universal vaccination of young people to prevent increases in HBV infection in Japan

Phylogenetic analysis and genotype distribution of Hepatitis B Virus (HBV) in Roraima, Brazil

Hepatitis B virus (HBV) infection is a serious global health problem. HBV has a high viral genetic diversity, with 10 genotypes recognized. In Brazil, the Roraima State is the third in the Northern region regarding the number of hepatitis B cases. On the other hand, few data on HBV genotyping and phylogenetic analysis are available. The purpose of this study is to characterize the HBV genotypes circulating in Roraima State. Of the 113 chronic hepatitis B patients enrolled in this study, 40 were HBV-DNA positive. A fragment of 280 bp (S gene) was amplified by PCR and submitted to nucleotide sequencing. A dataset containing the viral sequences obtained in this study, plus 130 obtained from GenBank was used for genotyping by phylogenetic analysis. The HBV subgenotype distribution found was A1 (62.5%), A2 (7.5%), D2, D3, D4 (2.5%), F2a (12.5%), and F3 (10%). We characterized the genotypes and subgenotypes of HBV circulating among patients in the State of Roraima. In addition, our study shows for the first time the HBV/F3 genotype circulating in Brazil. In conclusion, our findings showed a high diversity of HBV genotypes in Roraima, which is also found in other Brazilian geographical regions

Occult hepatits B virus (HBV) infection in the Chacma Baboon (Papio ursinus orientalis)

Members of the family Hepadnaviridae have been detected in both avian and mammalian species. They have a very limited host range, and among the nonhuman primates, have been found to occur naturally in chimpanzees, gorillas, gibbons, orang-utans and woolly monkeys. The human hepatitis B virus (HBV) has been shown to infect chimpanzees, Barbary macaques and tree shrews. During the course of a previous study, to determine the susceptibility of baboons (Papio ursinus orientalis) to HBV infection, HBV DNA was detected in the serum of 2 baboons prior to their inoculation with HBV-positive human serum, raising the possibility that baboons are naturally infected with a hepadnavirus. Therefore the aim of this study was to determine the prevalence of HBV in wildcaught baboons and to molecularly and functionally characterise the virus isolated from these baboons. DNA was extracted from the sera of wild-caught baboons and four separate regions of the HBV genome amplified by nested polymerase chain reaction (PCR). Samples were only considered to be positive for HBV if at least three of these regions amplified. DNA was extracted from the liver tissue of one of the HBV DNA-positive baboons using a proteinase K digestion followed by a phenolchloroform extraction and ethanol precipitation. From this extract, the complete HBV genome was amplified by nested PCR of eight overlapping subgenomic fragments, and sequenced. This sequence was analysed phylogenetically using both the PHYLIP and Simmonic software packages. A selective real time PCR using SYBR®-green detection was used to detect covalently closed circular (ccc) DNA. RNA was extracted from the baboon liver tissue using a guanidinium-acidphenol extraction method, reverse transcribed and portions of the HBV genome amplified by nested PCR. Transmissibility of the virus was tested by injecting four experimentally naïve baboons individually with serum from four HBV DNApositive baboons and followed for 26 weeks. HBV was detected in the serum of 5/69 (7,2%) wild-caught baboons by Southern hybridization and in 11/49 (22,4%) adult and 4/20 (20,0%) juvenile wild caught baboons. This gave an overall prevalence of 21,7% in the baboon population surveyed. Serologically, the baboon sera were negative for all markers of HBV infection and alanine aminotransferse (ALT) levels were normal. In the one baboon liver tissue available, HBcAg was detected by immunohistochemical staining in some of the hepatocyte nuclei, but HBsAg was not detected. Phylogenetic analysis of the complete genome of the HBV isolate found it to cluster with subgenotype A2, a surprising result considering that subgenotype A1 predominates in South Africa. However, unlike other subgenotype A2 isolates, the basic core promoter had the G1809T / C1812T double mutation characteristic of subgenotypes A1 and A3 and the precore region had the G1888A mutation unique to subgenotype A1. These mutations in the basic core promoter and precore regions have previously been shown to reduce the expression of the precore and core proteins. Four additional mutations in the polymerase, surface, X and core open reading frames (ORFs) further differentiated the baboon HBV strain form the majority of previously sequenced subgenotype A2 isolates. cccDNA was detected at low levels in the baboon liver tissue. Regions of the precore/core and surface ORFs were amplified off reverse transcribed cDNA. These results demonstrate HBV replication in the baboon liver. Transmission of the virus was shown by the detection of HBV DNA in the sera of the four inoculated baboons at various times throughout the 26 week follow-up period. These baboons also showed transient seroconversion for HBsAg and HBeAg during this period with intermittent fluctuations in ALT levels. Moreover, using DNA extracted from liver tissue obtained at necropsy from one of the injected baboons, the sequence of the HBV surface gene amplified was found to be identical to the sequence of the isolate from inoculum. The finding of subgenotype A2 in the baboon is paradoxical because subgenotypes A1 and A3 as well as genotypes D and E predominate in Africa. The possibility exists that subgenotype A2 is an older strain that has been overtaken by these other strains. There is however a scarcity of subgenotype A2 sequencing data from Africa and a higher circulation of this subgenotype could be uncovered with more extensive molecular epidemiological studies in more remote areas. Alternatively, a recent discovery of alternative compartmentalization of subgenotype A2 infections in the peripheral blood lymphocyte population of individuals from India, where subgenotype A1 also predominates, could explain the lack of detection of this subgenotype in Africa. Occult hepatitis B infection is defined as the presence of HBV DNA in the liver (with detectable or undetectable HBV DNA in the serum) of individuals testing negative for HBsAg by currently available assays. The detection of HBV DNA in the baboon liver and serum in the absence of serological markers therefore classifies this infection as occult. To our knowledge, this is the first study to demonstrate a naturally occurring occult HBV infection in non-human primates

Canine giardiosis in Sardinia Island, Italy: prevalence, molecular characterization, and risk factors

Introduction: The flagellate protozoan Giardia duodenalis causes infection in humans and in various animals. Eight distinct assemblages (A-H) have been identified within G. duodenalis; assemblages A and B are those specific to humans and animals, and assemblages C to H are restricted to animal hosts. Methodology: The present study estimated the prevalence of G. duodenalis assemblages in dogs living in the Sardinia region and evaluated the related risk factors. Individual fecal samples were collected from 655 dogs between January 2007 and December 2010, and a form was filled out for each animal to analyze historic data that were available at the time of sampling. Fecal samples were subjected to microscopic and genetic investigations. Results: Cysts of G. duodenalis were found in 172 (26.3%) samples, with significant values in puppies between three and nine months of age, and in kennelled and hunting dogs. The molecular characterization showed the presence of assemblages D (49%), C (36.1%), and subtype A2 (4.2%). Conclusion: The present survey contributes to the knowledge of the occurrence of canine giardiosis in Italy in a region with a high number of dogs and numerous animal movements, which is especially relevant for touristic reasons.</br

Withdrawal of Long-Term Nucleotide Analog Therapy in Chronic Hepatitis B:Outcomes From the Withdrawal Phase of the HBRN Immune Active Treatment Trial

INTRODUCTION:Withdrawal of nucleos(t)ide analog therapy is increasingly being evaluated in chronic hepatitis B infection as a strategy to induce hepatitis B surface antigen (HBsAg) loss. The Hepatitis B Research Network Immune-Active Trial evaluated treatment with tenofovir (TDF) for 4 years ± an initial 6 months of peginterferon-α (PegIFN) (NCT01369212) after which treatment was withdrawn.METHODS:Eligible participants (hepatitis B e antigen [HBeAg]-/anti-HBe+, hepatitis B virus [HBV] DNA &lt;103IU/mL, no cirrhosis) who discontinued TDF were followed for at least 1 year with optional follow-up thereafter. Retreatment was based on predefined criteria.RESULTS:Among 201 participants who received 4 years of treatment, 97 participants (45 TDF and 52 TDF + PegIFN arm, 79 Asian) discontinued TDF. HBsAg loss occurred in 5 participants, 2 within 25 weeks and 3 within 89-119 weeks postwithdrawal (cumulative rate 4.3% by 2 years). Alanine aminotransferase (ALT) flares (&gt;5× upper limit of normal) after TDF withdrawal occurred in 36 (37.1%) participants and occurred more frequently and earlier in those HBeAg- compared with HBeAg+ at treatment initiation. ALT flares were associated with older age and higher HBV DNA pretreatment and at the visit before the flare. ALT flares were not significantly associated with HBsAg decline or loss but were associated with immune active disease at 1 year (70.6% vs 11.9%, P &lt; 0.0001) and 2 years (66.7% vs 25.9%, P = 0.03) postwithdrawal. Treatment reinitiation was required in 13 (13.4%) participants, and 13 others remained in a sustained inactive carrier state by the end of the study follow-up. No criteria reliably predicted safe treatment withdrawal.DISCUSSION:Results from this trial do not support TDF withdrawal as a therapeutic strategy. HBsAg loss was infrequent within 2 years of stopping long-term TDF. If withdrawal is considered, HBV DNA should be carefully monitored with reinitiation of therapy if levels rise above 4 log10IU/mL to reduce the risk of ALT flares, as they were not associated with subsequent HBsAg decline or loss.</p

Molecular characterisation of hepatitis B virus isolated from human immunodeficiency virus-infected adults at various time points after the initiation of antiretroviral therapy

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine November 2017Sub-Saharan Africa is a high endemicity region of both Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) infection. There is a paucity of information in this highly endemic region on molecular evolution of HBV in HIV-infected individuals receiving longterm Lamivudine (Lam) therapy. This study aimed at characterizing the molecular evolution of HBV in HIV-infected black Southern Africans prior-to the initiation of a Lam- containing antiretroviral (ARV) drug regimen, and 3, 6, 12 and 18 months post-initiation. HBV viralloads were quantified using real-time PCR and used to determine the viral suppression in 39 participants from the Shongwe Hospital in rural Mpmualanga, Republic of South Africa. The study participants included 16 participants who were HBsAg+ and 23 HBsAg- at baseline. Of the HBsAg- participants, 19 remained negative throughout follow-up these were defined as the HBsAg- group. The remaining 20 participants were HBsAg+ at baseline and/or at one time-point during follow-up, are referred to as the HBsAg+ group, nine were HBsAg+ throughout the study. Seven participants sero-converted to HBsAg- at a median of 4.2 months, two participants gained the HBsAg at 18.3 months. Two participants were HBsAgat baseline, thereafter became sero-positive but had retro-converted to HBsAg- by last timepoint. A significant finding between these two HBsAg serological groups, was a higher viral suppression achieved in the HBsAg- group -100%, with the HBsAg+ group achieving 13.54% HBV suppression (p = 0.01). HBV was fully suppressed in ten participants, with no suppression found in the remaining participants 29, of which 10 experienced a virologic breakthrough (VBT). HBsAg-negativity was a predictor of viral suppression, with ten HBsAg-negative participants achieving full suppression of HBV (p = 0.01). The NS VBT+ group had a significantly higher percentage of viral suppression, 51,90%, compared to the NS VBT- group 14,35%, despite the VBT events (p = 0.03). Biochemical analysis revealed that baseline alanine transferase (ALT) levels were significantly lower in the full suppression (FS) group indicating that lower ALT levels are a predicator of viral suppression (p = 0.02). Participants in the FS group had significantly lower ALT levels (15.5) at baseline compared to the NS group (35) (p=0.02). Another finding of the study was that only participants belonging to the HBsAg-negative group were able to clear the HBV virus whereas HBsAg positivity at any time point precluded clearance of HBV DNA. The Basal Core Promotor/PreCore (BCP/PreC) and complete surface (S) regions were amplified and sequenced to genotype HBV isolated from this cohort, as well as find detection or immune escape mutations. The majority of HBV isolates belonged to subgenotype A1, with the exception of two baseline isolates that belonged to genotype E and subgenotype D3, respectively. Various mutations were found in the 61 BCP/PreC region sequences (T1753C, A1762T G1764A, Kozak sequence, G1862T, G1896A) that could account for the high prevalence of HBeAg-negative infections observed at the various time-points. These mutations can lead to the down regulation of PreC mRNA transcription or translation, and/or affect post-translational modification of HBeAg. Amplification of the complete S-region and overlapping Polymerase regions yielded 47 sequences. Twenty-three of these sequences were from baseline samples, and the remaining from follow-up time-points. PreS deletions involved in the development of HCC were found in two follow-up isolates. These deletions, and other immune or detection escape mutations found in the S region, may contribute to the HBsAg negativity found in this study. In conclusion ALT levels and HBsAg status at baseline were predictors of the outcome of HBV suppression in response to anti-retroviral therapy. This study adds to the limited information available on the molecular changes observed in HBV isolates in HIV-infected South Africans under selection pressure from Lam.MT 201

The relationship between hepatitis b virus and apoptosis in humans and in a transgenic mouse model

Hepatitis B virus (HBV) has been found to be highly endemic in Africa and south east Asia. In southern Africa, subgenotype A1 and genotype D prevail while in south east Asia genotype B and C predominate. Infection with HBV can lead to a wide spectrum of clinical presentations ranging from an asymptomatic carrier state to self-limited acute or fulminant hepatitis to chronic hepatitis with progression to cirrhosis and hepatocellular carcinoma (HCC). It has been shown that viral factors as well as a number of host and environmental factors can influence the course of HBV infection. Development and progression of various liver diseases are associated with either an increase or decrease in hepatocyte apoptosis. Dysregulated apoptosis itself may be a fundamental feature of most acute and chronic human liver diseases. The purpose of this study was to characterise the subgenotype A1 and genotype D HBV infection, prevailing in South Africa. To control for the influence of host factors on HBV infection as well as to avoid the use of in vitro cell lines, such as Huh-7, that have defective apoptotic pathways, the in vivo urokinase plasminogen activator severe combined immunodeficient (uPA-SCID) transgenic mouse model was utilised. The HBV infection of the transgenic mice infected with HBV positive sera containing either subgenotype A1 wildtype, subgenotype A1 with the G1862T mutation, subgenotype A2 or genotype D, was compared. For the first time, we were able to demonstrate the successful infection of the uPA-SCID transgenic mouse model with subgenotype A1 of HBV. The successful establishment of the in vivo HBV infection with different genotypes or subgenotypes in the uPA-SCID transgenic mice was demonstrated by the increase of HBV DNA levels, the presence of cccDNA and HBV transcripts as well as the detection of the core and/or surface HBV antigens in the liver tissue of the chimeric mice. Differences between the HBV infections with the various genotype/subgenotypes were observed. Subgenotype A1 with the G1862T mutation showed the earliest detection and therefore highest levels of cccDNA as well as the highest HBV DNA levels when compared to the other strains. The highest HBV DNA levels were recorded for the subgenotype A1 G1862T infected transgenic mouse followed by genotype D, subgenotype A2 and the lowest levels observed in the subgenotype A1 wild-type infected transgenic mouse. HBsAg was also only detected in the livers of mice infected with subgenotype A1 with the G1862T mutation. HBcAg staining in the chimeric liver was positive when the mice were infected with genotype D, which concurs with previous observations that genotype D is characterised by high HBcAg expression. Subgenotype A1 with the 1862 mutant showed the highest levels of apoptosis as a result of the abnormal precore precursor protein accumulation shown to be associated with this 1862 missense mutation. Thus different genotypes and subgenotypes as well as variations within genotypes can influence HBV infection. Moreover, the results of these experiments in the immunocompromised chimeric mice, grafted with liver cells from a single donor, suggests that even when host and environmental risk factors are controlled for, the subgenotype or genotype can influence the course of infection. The limitations of the uPA-SCID transgenic mouse model include the lack of an immune system and the short life-span of the animal; therefore a population based study was carried out to investigate the influence of host factors on HBV infection in various disease groups. The study cohort comprised 635 serum samples from South Africa, China and Japan. Of these samples, 564 were HBsAg-positive and the remaining 71 HBsAg-negative, HBV DNA negative controls. The study cohort included asymptomatic carriers; chronically infected HBV patients as well as patients with HBV associated HCC. Possible associations were determined between HBV genotype, HBV viral load, apoptosis levels, disease group and the age and gender of the patient where available. Apoptosis levels were quantified by the measurement of cleaved cytokeratin 18 (M30) in serum. Patients infected with genotype C or subgenotype A1 were shown to possess a higher odds ratios of developing HCC compared to subgenotype B2 or genotype D, respectively. Significantly higher HBV viral loads were observed in genotype C compared to subgenotype B2. Among the Asian cohort, it was also shown that the male gender was positively associated with high viral loads in HCC patients. Moreover, a positive association between higher HBV viral load levels and HCC in the South African cohort was observed. Male gender, older age, HBV viral load, subgenotype A1 and the presence of the G1862T mutation were shown to be positively and significantly associated with higher levels of apoptosis. In this study it was discovered that the levels of cleaved cytokeratin 18 could potentially be used as a biomarker for the severity of HBV infection because a significant difference was observed with the apoptosis levels between the asymptomatic and HCC patient disease groups. We conclude that even when the influence of host and environmental factors is controlled for, as is the case in the chimeric mouse model, the HBV genotype can affect the progression of infection. Moreover, it was shown in the population based study that the effect of HBV genotype on the outcome of HBV infection can be influenced by host factors. The subgenotype A1 G1862T mutation was shown in both studies to affect both HBV infection and apoptosis. This suggests that HBV variants should be investigated to ascertain their potential impact on the course of HBV infection as it may differ from the wild-type. Apoptosis was shown to be associated with HBV infection in both studies and could possibly be an ideal marker of the progression of HBV infection. These findings are important in helping us to understand factors influencing the course of HBV infection. We have therefore shown in both the studies that differences do exist between the South African subgenotype A1 and genotype D, and that these differences should be taken into consideration for the future evaluation of HBV infection and treatment of South African HBV infected patients. Moreover, cleaved cytokeratin 18 may provide an ideal surrogate marker for HBV disease progression and monitoring