Impact of the hepatitis B virus genotype and genotype mixtures on the course of liver disease in Vietnam

Hepatology. 2006 Jun;43(6):1375-84. doi: 10.1002/hep.21188.


Eight genotypes (A-H) of hepatitis B virus (HBV) have been identified. However, the impact of different genotypes on the clinical course of hepatitis B infection remains controversial. We investigated the frequency and clinical outcome of HBV genotypes and genotype mixtures in HBV-infected patients from Vietnam, Europe, and Africa. In addition, we analyzed the effects of genotype mixtures on alterations in in vitro viral replication. In Asian patients, seven genotypes (A-G) were detected, with A, C, and D predominating. In European and African patients, only genotypes A, C, D, and G were identified. Genotype mixtures were more frequently encountered in African than in Asian (P = .01) and European patients (P = .06). In Asian patients, the predominant genotype mixtures included A/C and C/D, compared to C/D in European and A/D in African patients. Genotype A was more frequent in asymptomatic compared with symptomatic patients (P < .0001). Genotype C was more frequent in patients with hepatocellular carcinoma (HCC; P = .02). Genotype mixtures were more frequently encountered in patients with chronic hepatitis in comparison to patients with acute hepatitis B (P = .015), liver cirrhosis (P = .013), and HCC (P = .002). Viral loads in patients infected with genotype mixtures were significantly higher in comparison to patients with a single genotype (P = .019). Genotype mixtures were also associated with increased in vitro HBV replication. In conclusion, infection with mixtures of HBV genotypes is frequent in Asia, Africa, and Europe. Differences in the replication-phenotype of single genotypes compared to genotype-mixtures suggest that co-infection with different HBV-genotypes is associated with altered pathogenesis and clinical outcome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asia
  • Base Sequence
  • Case-Control Studies
  • Cohort Studies
  • Disease Progression
  • Europe
  • Female
  • Gene Expression Regulation, Viral*
  • Genetic Predisposition to Disease / epidemiology*
  • Genetics, Population
  • Genotype
  • Hepatitis B virus / genetics*
  • Hepatitis B, Chronic / epidemiology
  • Hepatitis B, Chronic / genetics*
  • Hepatitis B, Chronic / physiopathology
  • Humans
  • Liver Cirrhosis / genetics*
  • Liver Cirrhosis / physiopathology
  • Liver Function Tests
  • Male
  • Middle Aged
  • Molecular Sequence Data
  • Probability
  • Prognosis
  • Reverse Transcriptase Polymerase Chain Reaction
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Vietnam / epidemiology