ID 88
HBV AND HDV GENOTYPES IN HBV/HDV COINFECTIONS IN THE STATE OF ACRE (WESTERN
BRAZILIAN AMAZONIA)
ALAN KAY1, HERMES PEDREIRA2, SUIANE NEGREIROS3, CIRLEY LOBATO3, WORNEI BRAGA4,
PAUL DÉNY1, MITERMAYER REIS2, FABIEN ZOULIM1,5, CHRISTIAN TREPO1,5, ARGEMIRO D
´OLIVEIRA JR6 AND RAYMUNDO PARANA2,6
1INSERM U871, LYON, FRANCE; 2CPQGM, FIOCRUZ, SALVADOR, BRAZIL; 3ACRE STATE
SECRETARIAT OF HEALTH, RIO BRANCO, BRAZIL; 4INSTITUTO DE MEDICINA TROPICAL DO
AMAZONAS, MANAUS, BRAZIL; 5SERVICE D'HÉPATO-GASTROENTÉROLOGY, HÔTEL DIEU,
LYON, FRANCE; 6 FEDERAL UNIVERSITY OF BAHIA, BRAZIL.
Although considered a vanishing disease in Europe and US, HDV still remains a serious public health
problem in Amazonia. We analyzed 101 HBsAg+/anti HDV IgG + patients, 68 males and 33 females,
from
Western
Brasilia
Amazonian
Referral
Centers.
Patient had mean age 32,61 (+/- 12,51), median 29 yo and 34/101 (37%) were under 25 yo. 20/101
(20%) were HBeAg positive, and 36/101 (36%) had cirrhosis. The mean age of HBeAg patients was
23.5
(+/-12.1)
x
33.2
(+/-12.5)
in
HBeAg
negative
ones.
(P=0.01).
Only 3/36 (8.1) cirhhotic patient were HBeAg positive, contrasting with non-cirrhotic cases 14/65
(21.5%)
(P=0.02).
Most
HBeAg
+
cases
came
from
Acre.
Sera samples were tested for the HBV genotypes by partial amplification and sequencing of the PreC/C
and/or the S genes. For HDV by partial amplification of the HDV genome and hybridization with HDV
genotype-specific probes. 69 samples could be genotyped for the HBV and 85 for HDV. All HDV
samples were genotype III. Regarding HBV, 37 (53,6%) were F (most F2), and 20 (23,9%) A (13 A1
and 7 A2) and 7(17,1%) genotype D (4 D3). In 04 (5,7%) patients we had discordance depending on
Per S or Pre C sequencing, probably because recombinant genotypes (02 were D/F; 1 A/C; 1 C/F) and
only 01 patient were genotype C. Mean age of HBV F carriers was 31.9(+/-12.6) x 33.2 (+/-13.8) among
non
F
carriers.
(P=0.74)
Concerning HDV, in 17/85 (20%) we observed a rare mutation at the Ag gene, changing the second
from last amino acidend of the small phenylalanine to tyrosine. Mean age of Mutant and non-Mutant
Gen III carriers was 31.3 (+/- 12.6) and 31.7 (+/- 10.2). In 14 HDV mutants who HBV gen could be
performed, 09 were HBV non-F genotype and 05 HBV F (P=0.84). Among 17 patients with mutant
HDV, 5/25 (29.9%) had cirrhosis compared to 12/57 non-cirrhotic patients (P=0.91). HBV F gen was
present in 14/37(37.8%) of cirrhotic patients x 23/50 (71.6%) non-Cirrhotic ones (P=0.06).
In conclusion: 1. We described a HDV gen III mutant in Amazonia, probably more likely to be
associated with non-F HBV genotypes. 2. High frequence of HBeAg + status of the Acre patients is
probably related to patient ´s age. 3. Non F HBV Genotypes, mainly Gen A is also prevalent in this
population. 4. A larger clinic/molecular epidemiological study will be necessary to define the role of HBV
F genotypes and HDV mutant Genotype III in the pathogenicity of liver disease.