HBV/A and HBV/C genotype predominance among patients with chronic hepatitis B virus infection in Cebu City, Philippines.

ABSTRACT

CONTEXT Chronic Hepatitis B virus (HBV) infection causes significant morbidity and mortality with widespread global distribution. Different genotypes display variations in pathogenesis, disease behavior, and treatment response. HBV/B and HBV/C are prevalent in Asia, but minimal data come from the Philippines. OBJECTIVE: This study is aimed to determine the HBV genotypes of Filipino patients with Chronic HBV infection seen in Cebu City, Philippines and describe the age, sex, viral activity, alanine aminotransferase (ALT) levels and viral load patterns by genotype. STUDY DESIGN: Case series with prospective mode of data collection. STUDY SETTING: Gastroenterology specialty clinics, Cebu City, Philippines. STUDY POPULATION Patients with Chronic HBV infection seen in 2008. MANEUVERS Chronic HBV infection was defined as HBsAg(+) for >6 months with persistent/intermittent ALT/aspartate aminotransferase levels (AST) elevations. Hepatitis panel and biochemical tests determined disease activity. Ultrasound documented liver cirrhosis with corresponding hypoalbuminemia and prolonged Prothrombin time. Hepatitis C virus (HCV) co-infection was a reactive anti-HCV test. Hepatocellular carcinoma was diagnosed by ultrasound or computed tomography (CT) scan with alpha-feto protein (AFP) > 500 ng/L. COBAS Taqman HBV Test(®) determined HBV-DNA level. Polymerase chain reaction (PCR) genotyping was done using type-specific primers. RESULTS: This study analyzed data from 50 patients, where 74% were males, and median age was 31 years (IR 25-40 years.). Chronic active hepatitis was seen in 76.6%. Only 18% had ALT levels >2 × ULN. Viral loads >20,000 IU/L were reported in 71% of HBeAg(+) patients. Viral loads >2,000 IU/L were seen in 73% of HBeAg(-) patients. Predominant genotypes identified were HBV/A (28%) and HBV/C (26%). No significant correlation between genotype and age (p = 0.92) and ALT levels (p = 0.58) was determined. Consistently high-DNA titers were reported for 83% of HBV/C patients and for all patients with >1 HBV genotypes. Hepatocelullar carcinoma was noted for one patient with HBV/A. Two patients with liver cirrhosis had HBV/C. LIMITATION: Possible significant associations between genotype and some patient-related parameters could not be determined due to scarcity of subjects. CONCLUSION: HBV/A and HBV/C genotypes are equally predominant among Filipino patients with Chronic HBV infection seen in two specialty clinics in Cebu City, Philippines.