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Hepatitis B virus subtypes and hepatitis C virus genotypes in patients with chronic liver disease in Nepal
S M Shrestha1, F Tsuda, H Okamoto
1Liver Unit, Bir Hospital, Kathmandu, Nepal.
Insights
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are prevalent in Nepal, with atypical HBV subtypes and novel HCV genotypes identified. Further research is needed to understand their impact on chronic liver disease.
Area of Science:
- Hepatology
- Virology
- Epidemiology
Background:
- Chronic liver disease is a significant health concern in Nepal.
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of chronic liver disease globally.
- Limited data exists on the prevalence and characteristics of HBV and HCV in Nepal.
Purpose of the Study:
- To determine the prevalence of HBV and HCV infections in patients with chronic liver disease in Nepal.
- To characterize the subtypes of HBV and genotypes of HCV prevalent in the Nepalese population.
- To identify potential novel HBV and HCV variants in Nepal.
Main Methods:
- Serological testing for hepatitis B surface antigen (HBsAg) and hepatitis C virus antibodies.
- Detection and genotyping of hepatitis C virus RNA using polymerase chain reaction (PCR).
- Subtyping of HBsAg-positive samples.
- Sequence analysis of hepatitis C virus E1 region for unclassifiable isolates.
Main Results:
- HBsAg was detected in 39% of patients with chronic liver disease, and HCV RNA in 8%.
- Atypical HBV subtypes (ad, ay, a) were found in 15% of HBsAg-positive samples.
- Five unclassifiable HCV isolates showed significant genetic diversity within the E1 region, suggesting novel genotypes.
Conclusions:
- Hepatitis B and C virus infections are common among individuals with chronic liver disease in Nepal.
- The findings suggest the circulation of atypical HBV subtypes and novel HCV genotypes in Nepal.
- These results highlight the need for further epidemiological and molecular studies to understand the full spectrum of HBV and HCV in the region.
Abstract:
A total of 145 patients with chronic liver disease, including 20 with chronic hepatitis, 63 with cirrhosis and 62 with primary hepatocellular carcinoma from Nepal were tested for markers of hepatitis B virus or hepatitis C virus infection. HBsAg was detected in 57 (39%) and hepatitis C virus RNA in 12 (8%); the cause of liver disease was not known in the remaining 76 (52%). HBsAg was found in 5 (1.3%) of 379 normal controls, whereas hepatitis C virus-associated antibodies were detected in 13 (3.4%), none of whom was positive for serum hepatitis C virus RNA. Subtypes of 102 HBsAg samples, from patients and asymptomatic carriers, were adw in 35 (34%), adr in 4 (4%) and ayw in 48 (47%); the remaining 15 (15%) were of atypical subtypes such as ad, ay and a. Of 12 hepatitis C virus RNA samples, genotype I was detected in 1, genotype II in 5 and genotype V in 1; the remaining five samples were not to be classified by polymerase chain reaction with primers specific for genotypes I to V deduced from hepatitis C virus core sequences, despite high hepatitis C virus RNA titers in all of them. Sequences of 192 amino acids in the entire E1 region of unclassifiable hepatitis C virus isolates from five patients differed from each other in 17% to 23%, and varied from reported isolates of defined genotypes in 13% to 44%. These results indicate that atypical subtypes of hepatitis B virus and novel genotypes of hepatitis C virus would prevail in Nepal.