ABSTRACT
BACKGROUND: Understanding the prevalence of potential antigenic variation of the hepatitis B virus (HBV) surface antigen (HBsAg) is fundamental for assay design and to future changes in vaccine formulation. In this study, the nature and frequency of HBsAg polymorphisms occurring in France in chronic carriers and in newly diagnosed patients were determined. We focused on variations in the major hydrophilic region (MHR), the central core of HBsAg known to be exposed on the surface and involved in antibody binding. METHODS: Two patient groups were identified: 51 chronic HBV carriers followed at our institution for > 1 year; and 129 newly diagnosed patients (63 of whom had a first HBsAg-positive result at our hospital laboratory and 66 a first positive result in a private laboratory). DNA sequences of HBsAg were obtained from these 180 patients and compared with consensus sequences built with 168 full-length HBV sequences imported from GenBank. Polymorphisms of the MHR of HBsAg were analysed with the Mutation Master Software. Literature review and BLOSUM scores were used to define potentially altered antigenicity. RESULTS: The global frequency of MHR variants was 27.8%. Occurrence of MHR variants was independent of viral load, HBeAg status and sex, but was associated with the chronic carriers' group, advancing age, the presence of antibodies to HBsAg, immunoprophylaxis administration, antiviral treatment and genotypic resistance to antivirals. In multivariate analysis, the independent variables associated with MHR variants were advancing age and the presence of genotypic resistance to nucleoside or nucleotide analogues. CONCLUSION: Most MHR variants emerge with longer disease duration and upon indirect selective pressure. Variation of the MHR may serve to restore virus replication of resistant strains. Combined envelope and polymerase variants could impair diagnostic assays and limit treatment alternatives.
Subject(s)
Hepatitis B Surface Antigens/genetics , Hepatitis B virus/genetics , Hepatitis B/virology , Age Factors , Amino Acid Sequence , Carrier State , Drug Resistance, Viral/genetics , Female , France , Hepatitis B/blood , Hepatitis B/drug therapy , Hepatitis B Antibodies/blood , Hepatitis B Surface Antigens/immunology , Hepatitis B virus/drug effects , Hepatitis B, Chronic/virology , Humans , Male , Middle Aged , Molecular Sequence Data , Nucleosides/pharmacology , Nucleotides/pharmacology , Polymorphism, Genetic , Sequence Alignment , Viral LoadABSTRACT
BACKGROUND: Interferon-alpha (IFN-alpha)and ribavirin combination therapy for chronic infection with hepatitis C virus produces a number of well-described side effects. Combination therapy with pegylated interferon (PEG-IFN) yields an adverse event profile similar to that observed with the standard IFN, although the frequency of certain adverse events may vary according to the preparation. CASE REPORT: We report the case of a 44-year-old man who was treated with ribavirin and PEG-IFN-alpha-2b for chronic hepatitis C and developed two rare side effects simultaneously on the 16th week of therapy: severe thrombocytopenia and nephrotic syndrome due to focal segmental glomerulosclerosis. The antiviral treatment was immediately interrupted and the patient received immunosuppressive therapy. He promptly recovered from the thrombocytopenia and partially and slowly from the nephrotic syndrome. To our knowledge, this is the first case reported of the development of such complications at the same time.
