Viral hepatitis: Past, present, and future.

Each hepatitis virus-Hepatitis A, B, C, D, E, and G-poses a distinct scenario to the patient and clinician alike. Since the discovery of each virus, extensive knowledge regarding epidemiology, virologic properties, and the natural clinical and immunologic history of acute and chronic infections has been generated. Basic discoveries about host immunologic responses to acute and chronic viral infections, combined with virologic data, has led to vaccines to prevent Hepatitis A, B, and E and highly efficacious antivirals for Hepatitis B and C. These therapeutic breakthroughs are transforming the fields of hepatology, transplant medicine in general, and public and global health. Most notably, there is even an ambitious global effort to eliminate chronic viral hepatitis within the next decade. While attainable, there are many barriers to this goal that are being actively investigated in basic and clinical labs on the local, national, and international scales. Herein, we discuss pertinent clinical information and recent organizational guidelines for each of the individual hepatitis viruses while also synthesizing this information with the latest research to focus on exciting future directions for each virus.

Human pegivirus type 1 infection in Asia-A review of the literature.

The human pegivirus type 1 (HPgV-1)-as known as hepatitis G virus and GB virus C-is a common single-stranded RNA flavivirus. Because few studies have demonstrated an association between HPgV-1 infection and disease, screening for HPgV-1 is not performed routinely. Nonetheless, a beneficial impact of HPgV-1 infection on HIV disease progression has been reported in multiple studies. Given the burden of HIV in Asia and the complex interactions between viral co-infections and the host, we provide a comprehensive overview of the existing data from Asia on HPgV-1 infection, including the prevalence and circulating genotypes in all Asian countries with data reported. This review highlights the research conducted thus far and emphasizes the need for additional studies on HPgV-1 across the Asian continent.

Viral Hepatitis in pregnancy.

The global prevalence of viral hepatitis is very high and seems to be rising over the years. The infection can profoundly affect pregnant women causing significant maternal and perinatal morbidity and mortality with some strains much worse than others. Hepatitis A (HAV) and E (HEV) which are transmitted mainly through the faecal-oral route present as acute hepatitis during pregnancy and are responsible for most local epidemic outbreaks. HAV infection remains self-limiting during pregnancy, while HEV has a higher prevalence and causes significant morbidity. It is also associated with a very high maternal mortality rate (20 %) and requires special attention in endemic areas. HEV vaccines do exist, but the WHO has yet to approve them for general use. Hepatitis B is the most prevalent form and is part of the ante-natal screening program. The presence of HBeAg is associated with high viral loads and infectivity. Antiviral therapy, preferably tenofovir (TDF), is recommended for mothers with viral load ≥ 200,000 IU/mL2), with the neonates receiving both active and passive immunisations. Hepatitis C and D are usually found as chronic infections in the pregnant and non-pregnant populations. Screening for hepatitis C during pregnancy and its subsequent management is still unsettled, but the introduction of direct-acting antiviral (DAA) drugs will change the picture if their safety is established in pregnancy. HDV is an incomplete virus linked to HBV and cannot establish an infection on its own. Controlling HBV is paramount to controlling HDV. HEV is quite prevalent and looked upon as hepatotropic. It seems to be quite prevalent in some blood donor populations and has a high co-infection rate with HCV. It has a high Mother-to-Child-Transmission (MTCT) but causes little or no illness in infected infants, and antenatal screening is not justified. This review summarises the prevalence, clinical picture, maternal, perinatal effects, and the management and prevention of hepatitis A, B, C, D, E and G viral infections during pregnancy.

Fighting the Public Health Burden of AIDS With the Human Pegivirus.

Highly active antiretroviral therapy has revolutionized the battle against human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). From its current global rollout, HIV/AIDS morbidity and mortality has been greatly reduced, yet there exists substantial interest in the development of new therapies to further mitigate the HIV/AIDS health burden and to inhibit any fallout from the development of antiretroviral drug resistance. One potential intervention is the human pegivirus (HPgV). HPgV is not known to cause disease, and most remarkably it is shown to delay the progression of HIV to AIDS. However, the health benefit of increasing HPgV prevalence in the community of HIV-infected men remains unknown at the public health level. We evaluated the utility of HPgV biovaccination for mitigating the HIV/AIDS health burden using mathematical models. Importantly, our work considers the potential concern that HPgV will, itself, evolve to become disease-causing by permitting mutant disease-causing HPgV strains to potentially arise during treatment. Our findings show that HPgV biovaccination rates of 12.5%-50% annually could prevent 4.2-23.6 AIDS incidences and 3.3-18.8 AIDS deaths, and could save 2.9-18.6 disability-adjusted life years per 1,000 people. Together, these findings indicate that HPgV biovaccination could be an effective therapy for reducing HIV/AIDS morbidity and mortality, and thus warrants further exploration.

The human pegivirus: A new name for an "ancient" virus. Can transfusion medicine come up with something new?

Human pegivirus (HPgV, formerly called GB virus C/hepatitis G virus) is a poorly understood RNA virus of the Flaviviridae family. The HPgV infection is common worldwide and the virus is likely transmitted by blood products. At this time, no causal association between HPgV and human diseases has been identified. While waiting for new findings to better understand the Pegivirus genus, the aim of our narrative review is to discuss the currently available information on HPgV focusing on its prevalence in blood donors and its potential threat to transfusion safety.

The Impact of Human Pegivirus on CD4 Cell Count in HIV-Positive Persons in Botswana.

BACKGROUND: Human pegiviruses (HPgV)-formerly known as hepatitis G virus or GB virus C (GBV-C)-are common single-stranded RNA viruses that may have a beneficial impact on slowing HIV disease progression. The data on HPgV in resource-limited regions such as Sub-Saharan Africa are scarce. Thus, we conducted the first study of HPgV in Botswana as part of a natural history study of HIV subtype C disease progression. METHODS: Plasma samples from 133 HIV-positive adults were evaluated for HPgV RNA, and the 5'UTR was sequenced to determine the HPgV genotype. RESULTS: HPgV RNA was detected in 41 (30.8%) individuals. While the presence of HPgV RNA had no impact on baseline HIV viral load, a significant difference in baseline CD4 cell count was observed. HPgV genotypes were determined for 27 individuals and included 5 individuals (18.5%) with genotype 1 and 22 (81.5%) with genotype 5. Baseline CD4 cell counts were significantly higher for persons infected with HPgV genotype 5 compared with genotype 1. CONCLUSIONS: These data suggest that HPgV infection is common among HIV-positive individuals in Botswana and has a significant impact on CD4 cell count. This difference in CD4 cell count based on HPgV genotype suggests that HPgV genotype should be evaluated as a possible predictor of HIV disease progression and highlights the need for additional studies of this virus in resource-limited settings.

Study of the interaction of GB virus C/Hepatitis G virus fusion peptides belonging to the E2 protein with phospholipid Langmuir monolayers.

In order to determine the ability of 1,2-dipalmitoyl phosphatidylcholine (DPPC) and 1,2-dioleoyl phosphatidylglycerol (DOPG) to host peptide sequences belonging to the E2 protein of GBV virus C/Hepatitis G virus, the behaviour of Langmuir monolayers formed by these phospholipids and E2 (12-26), E2 (354-363) and E2 (chimeric) peptide sequences was analysed from data of surface pressure (π) versus area per molecule (A) isotherms, compression modulus (Cs-1), excess Gibbs energy of mixing (ΔGexc) and total Gibbs energy of mixing (ΔGmix). Three different behaviours were observed. Mixed films of E2 (12-26) with DPPC or DOPC showed negative values for the excess thermodynamic functions, and thus attractive interactions between mixed films components are greater than in ideal films. Mixtures of E2 (354-363) with DPPC or DOPG, exhibited positive values of excess functions, evidencing weaker interactions in the mixed films in relation to those of pure components. Finally, positive and negative excess functions were observed in E2 (chimeric)/DPPC or DOPG mixed films, depending on their composition. In short, the interaction between the phospholipids used in this work as models of cell membranes and E2 peptides varies with the type of phospholipid and the nature of the peptide (size, bulky, hydrophobicity and electric charge).

Prevalence and vertical transmission of human pegivirus among pregnant women infected with HIV.

OBJECTIVE: To determine the prevalence of human pegivirus (HPgV) and factors associated with vertical transmission among pregnant women infected with HIV. METHOD: A retrospective cross-sectional study was conducted among pregnant women treated at an HIV reference service in Rio Grande, Brazil, between January 1, 2010, and January 1, 2015. The polymerase chain reaction was used to diagnose HPgV infection among the women and their neonates. Clinical, obstetric, and neonatal data were obtained from medical records. RESULTS: Infection with HPgV was detected among 16 (25%) of 63 women and 5 (8%) of 63 newborns, corresponding to a vertical transmission rate of 31%. Multivariate analysis demonstrated that the absence of prenatal care was the only risk factor for vertical transmission of HPgV (prevalence ratio 19.61, 95% confidence interval 1.29-297.48; P=0.032). CONCLUSION: Prenatal care could protect against vertical transmission of HPgV among women infected with HIV; however, studies among HIV-negative individuals are still required to verify this correlation.

Hepatitis C and G Virus Infection Prevalence Among Hemodialysis Patients and Associated Risk Factors in the Hormozgan Province of Southern Iran.

BACKGROUND: Infection with blood-borne viruses including hepatitis C (HCV) and hepatitis G (HGV) viruses is a substantial health problem. Varying prevalences of these infections in different studies reflect the role of predisposing risk factors in different countries or even different regions of a country. OBJECTIVES: The objective of the present survey was to assess the prevalences of HCV and HGV virus infections among hemodialysis (HD) patients in Bandar Abbas, Hormozgan, Iran, 2015. METHODS: A total of 149 subjects with chronic renal failure undergoing HD at Shahid Mohammadi hospital in the Hormozgan province of southern Iran from January 1, 2015 to March 31, 2015 were evaluated for anti-HCV and antibodies against HGV E2 glycoprotein by census sampling method. Thereafter, all of the specimens were evaluated for molecular assays using polymerase chain reaction (PCR) and other techniques. Investigated data were recorded for each participant in a pre-designed data collection sheet. All statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 19 for Windows by t-test and chi-square test (χ2). RESULTS: The mean age of patients was 56.23 ± 12.35 years (minimum age 18, maximum age 85). Both kinds of assays determined that five (3.36%) patients were HCV positive, whereas no HGV positives were diagnosed. The prevalence of HCV is associated with longer duration of HD (P value = 0.008), history of blood transfusion (P value = 0.037) and drug addiction (P value = 0.035). CONCLUSIONS: History of drug addiction and/or blood transfusion and longer duration of HD treatment were the main risk factors determining the prevalence of HCV infection in the Hormozgan province of southern Iran in 2015. However, the values observed in the present investigation reflect the effective management techniques imposed by healthcare authorities and relevant organizations in recent years.

Association between Hepatitis G and Unknown Chronic Hepatitis.

BACKGROUND: Hepatitis G virus (HGV) is a hepatotrope virus with unknown importance. The genome of the virus has been detected in patients with acute or chronic non-A-E hepatitis, cirrhosis, and hepatocellular carcinoma. The aim of this study was to determine the association between hepatitis G and unknown chronic hepatitis. METHODS: This case-control study was performed in Ebne-Sina military hospital in Hamadan, Iran. The cases were 35 military staff with unknown chronic hepatitis. The control group consisted of 59 healthy subjects who had normal levels of serum alanine aminoteransferase (ALT). The data were analyzed by SPSS, version18, using Fisher's exact test, the Student's t-test, and multivariate logistic regression analysis. RESULTS: Only one patient in the case group (2.9%) tested positive for HGV antibodies, and no one was infected in the control group. There was no association between HGV infection and unknown chronic hepatitis in our study (P=0.37). A significant association was found between the male gender and unknown chronic hepatitis (OR=14.9, P=0.01). CONCLUSION: No association between HGV infection and unknown chronic hepatitis was found in our study, so it was not necessary to evaluate these patients for HGV infection.

Virus against virus (VIVI): a potential solution against HIV/AIDS.

Most therapeutic regimens are aimed at the use of pharmacologic agents or the induction of immunological response against the pathological agent. However, these methods tend to be insufficient for the management of some of the most debilitating infectious diseases. Here we present a novel therapeutic approach. It involves voluntary super-infection of a subject having HIV/AIDS with a virus (GBV-C), which to date has not been shown to be responsible for any pathology. It has been shown to counter, suppress or eradicate the agent responsible for the severe disease. Several studies demonstrate the role of different micro-organisms in influencing the growth of other pathogens in the human body. This hypothesis requires meticulous testing before its implementation on humans. If the trials are successful, the implications for this hypothesis are promising considering the compliance issues and adverse effects associated with current standard of HIV care.

Epidemiology of GB virus type C among patients infected with HIV in Singapore.

Several studies have shown that individuals co-infected with GB virus type C (GBV-C), and human immunodeficiency virus (HIV) have slower progression to acquired immunodeficiency syndrome (AIDS) and a prolonged lifespan, compared to those infected with only HIV. In Singapore, despite the steadily increasing number of HIV infections in recent years, there are no studies documenting the extent of GBV-C/HIV co-infection in this group of patients. To fill this dearth of information, two GBV-C screening assays was performed on 80 archived HIV-1-positive samples from the National University Hospital. The overall prevalence of GBV-C co-infection among patients infected with HIV in this study was 10% (8/80). Phylogenetic analysis of the eight dual-infection cases revealed that genotypes 3 (4/8, 50%) and 2a (2/8, 25%) were the main genotypes circulating among these Singaporean HIV patients. One case each of genotypes 2b (1/8, 12.5%) and 4 (1/8, 12.5%), which have not been described previously in Singapore, were identified. These findings hint at the complex epidemiology of GBV-C in different patient groups and a larger study would be needed to characterize, and understand the potential clinical impact of GBV-C co-infection on the patients.

Hepatitis G virus exposure in dialysis patients and blood donors in Isfahan-Iran.

BACKGROUND: Hepatitis G virus (HGV) is transmitted mainly by parenteral route and patients on maintenance hemodialysis (HD) are at risk for this infection. This study was conducted to estimate prevalence of infection through the presence of anti-HGV and to evaluate the clinical significance of HGV envelope protein E2 (anti-E2) in HD patients in compare with volunteer blood donors in Isfahan-Iran. METHODS: In a cross-sectional study, a total of 40 HD patients as cases and 40 healthy volunteer blood donors as negative controls were selected randomly in summer 2008. The epidemiological data were obtained in all subjects, and duration of HD was obtained in HD patients as well. All samples were tested for anti-E2 antibodies, hepatitis C virus (HCV)-antibody and hepatitis B virus surface antigen (HBs-Ag) by an enzyme-linked immunosorbent assay and a recombinant immunoblot assay was employed to confirm anti-HCV reactivity. Student's t-test, Chi-square test or Fisher exact test was used for data analysis and P < 0.05 was considered as statistically significant. RESULTS: Ten of the 40 HD patients tested positive for anti-E2 (25%) and of 40 voluntary blood donors, 10 (5%) were positive for anti-E2 (P = 0.012). Anti-HCV antibodies and HBs-Ag were found in 4 and 1 HD patients, respectively. In anti-E2-positive patients, co-infection with HCV or hepatitis B virus was not significant. Furthermore, the mean duration of hemodialysis in anti-E2 positive and anti-E2 negative patients did not have significant differences. CONCLUSIONS: HD patients are at increased risk of HGV infection in Isfahan-Iran. Since hepatitis G is a good predictor for parenteral transmission, it is suggested to test all of the blood for transfusion for HGV infection.

HGV-HCV/HBV co-infection in India: A pilot study.

BACKGROUND: Hepatitis G virus (HGV) is newly identified virus, transmitted by infected blood and blood products. Effect of HGV infection on liver diseases is not well known. AIMS: Co-infection of HGV with hepatitis B virus (HBV) and hepatitis C virus (HCV) infection has been reported however; very limited data is available from India. Therefore, we have performed a pilot study for the presence of co-infection of HGV in chronic liver disease patients. SETTING AND DESIGN: The study was performed in research laboratory at P.D. Hinduja National hospital and Medical research center, Mahim, Mumbai. Prospective study was designed. METHODS AND MATERIALS: Forty HBV, HCV related chronic liver disease patients were studied. Forty randomly selected voluntary healthy blood donors visiting our blood bank were included as controls. Serum bilirubin, alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were estimated. HGV infection was detected by using reverse transcriptase molony murine leukemia virus (M-MLV) with the help of HGV 340/625IC kit (Sacace, Italy). RESULTS AND CONCLUSION: One HCV positive patient had infection with HGV among 40 HBV/HCV chronic liver disease patients.

Hepatites virais: B, C e D: atualização / Viral hepatitis: B, C and D: an update

JUSTIFICATIVA E OBJETIVOS: As hepatites causadas pelos vírus da hepatite B (VHB), vírus da hepatite C (VHC) e vírus da hepatite (VHD) têm como aspecto comum a transmissão por via parenteral e a possibilidade de cronificação. Revisar os aspectos clínico-epidemiológicos, diagnósticos, terapêuticos e profiláticos das infecções virais por tais agentes é o escopo do presente artigo. Realizou-se pesquisa bibliográfica nas bases de dados Scielo e Pubmed empregando-se os descritores hepatite B (hepatitis B); hepatite C (hepatitis C); hepatite D (hepatitis D) e hepatite G (hepatitis G), assim como livros texto, consensos e diretrizes relacionadas ao tema.CONTEÚDO: As formas agudas das hepatites B, C e D são usualmente benignas, podendo, sem embargo, ocorrerem quadros de hepatite fulminante. Em situações nas quais o sistema imunológico não é capaz de depurar o VHB e/ou VHC, há cronificação da infecção, com risco de desenvolvimento de cirrose e consequente insuficiência hepática crônica, bem como carcinoma hepatocelular. As hepatites B e D são imunopreveníveis, graças à vacina parao vírus B, mas, até o momento, não há imunoprofilaxia disponível para o vírus C.CONCLUSÃO: As hepatites pelos VHB e VHC constituem importantes desafios para a medicina atual, especialmente pela prevalência das infecções no planeta e pelo risco de desenvolvimento das complicações crônicas. Neste contexto, destaque-se a importância da avaliação diagnóstica, da instituição da terapêutica adequada e do emprego das medidas preventivas para tais infecções, elementos que devem ser solidamente conhecidas pelo clínico.

BACKGROUND AND OBJECTIVES: Hepatitis caused by hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) have in common the transmission by parenteral route and the possibility of chronification. Reviewing the clinic, epidemiology, diagnose, therapeutics and prophylaxis of viral infections by these agents is the scope of this work. Bibliographic research was conducted both at databases Scielo and Pubmed through the chosen descriptors: hepatitis B, hepatitis C, hepatitis D and hepatitis G, and text books, consensus and guidelines related to the subject.CONTENTS: The acute viral B, C and D hepatitis are usually benign, though acute liver failure, fulminant hepatitis, may occur. In the cases when the immune system is unable to debug HBV and HCV the infection becomes chronic, cirrhosis with consequent chronic liver insufficiency and hepatocellular carcinomamay develop. HBV and HDV are immunopreventable, thanks to the hepatitis B virus vaccine, but at this point there's no immunoprophylaxis available for hepatitis C virus. CONCLUSION: HBV and HCV hepatitis are great challenges for medicine, particularly due to the prevalence of infections worldwide and the risk of chronic complications. In this context, diagnostic evaluation, adequate therapeutic care, and preventive measures must be soundly known by the physician.

Hepatitis viruses and non-Hodgkin's lymphoma: A review.

Non-Hodgkin's lymphoma (NHL) is among the haematological malignancies with high prevalence worldwide, causing estimated 355 900 new cases and 191 400 deaths in 2008. High prevalence of NHL is documented in economically more developed areas while low prevalence is observed in less developed areas of the globe. A wide array of environmental factors have been reported to be either directly involved or in modifying the risk of NHL development. In addition to these factors, a number of infectious agents, chiefly viruses have also been implicated in the development of NHL. This article reviews the available literature to discuss the role of hepatitis viruses in NHL development, possible mechanisms of lymphomagenesis and also identify the areas in which further research is required to better understand this disease. A brief discussion on the clinical aspects such as classification, staging, treatment approaches have also been included in this article.

Analysis of GB virus C infection among HIV-HCV coinfected patients / Análise da infecção pelo vírus GB-C em pacientes com coinfecção VIH-VHC

The aim of this study was to evaluate the effect of GB virus C on laboratory markers and histological parameters among HIV-seropositive patients coinfected with HCV. Lower degrees of hepatic lesions were observed in the triple-infected patients, in comparison with HIV-HCV coinfected patients who were negative for GBV-C RNA.

O objetivo do estudo foi avaliar o efeito da infecção pelo vírus GB-C em marcadores laboratoriais e parâmetros histológicos em pacientes HIV soropositivos coinfectados com VHC. Menor grau de lesão hepática foi observado nos pacientes com tripla infecção em comparação aos pacientes coinfectados com VIH-VHC negativos para GBV-C RNA.

Hepatitis G Virus Infection in Healthy Individuals, Acute Viral Hepatitis and Persons at Risk for Parenteral Transmission.

BACKGROUND: Hepatitis G virus (HGV), transmitted mostly by parenteral route, has been under investigation for its role as an agent for viral hepatitis. This study was carried out to find out the prevalence of HGV in healthy individuals, multi-transfused patients with acute viral hepatitis and those under going dialysis. METHOD: The study included 200 healthy individuals and 180 patients, comprising acute viral hepatitis (100 cases), multi-transfused patients (50 cases) and patients undergoing dialysis (30 cases). HGV RNA and Hepatitis C virus (HCV) RNA was detected by reverse transcription and polymerase chain reaction (RT-PCR) in all. Viral marker studies for hepatitis A, B and E were carried out by ELISA in acute viral hepatitis cases. In healthy individuals, in patients with multiple transfusions or those undergoing dialysis, marker studies for HBV and HCV were carried out. RESULT: The prevalence of HGV in healthy individuals was 2.5% (5/200), in non A-E hepatitis 3% (3/100), in multi-transfused patients 4% (2/50) and in patients undergoing dialysis 6.67% (2/30). There was no significant difference in the prevalence rate of HGV infection in healthy individuals and in patients with non A-E hepatitis. CONCLUSION: Depending on prevalence rate, HGV could not be implicated as cause of acute viral hepatitis. Persons with parenteral risk factor (multiple blood transfusions and those undergoing dialysis) had higher prevalence rate as compared to healthy individuals.

Hepatitis G Virus: Prevalence in Blood Donors in Armed Forces.

BACKGROUND: A new RNA virus designated hepatitis G virus (HGV) was recently identified. Because HGV has less than 25% sequence or amino acid homology with hepatitis C virus (HCV) and other established Flaviviridae, it is considered to be a new genus in this growing family of hapatotropic viruses. Hepatitis G virus has been associated with hepatitis and is transmitted through parenteral and sexual route. MATERIAL AND METHODS: A study comprising 500 healthy voluntary blood donors (service personnel) was under taken to find out prevalence of HGV. HGV RNA was detected by reverse transcriptase - polymerase chain reaction (RT-PCR). Hepatitis B surface antigen (HbsAg) and antibody to HCV were detected by Enzyme Linked Immunosorbent Assay (ELISA). RESULTS: Thirteen donors (2.6%) were positive for HGV RNA. 17 donors (3.4%) were positive for antibody to hepatitis C virus (HCV) by ELISA. Co-infection of HGV with hepatitis B virus (HBV) was seen in 5 donors and with HCV infection in 2 donors. Co-infection of HGV, HBV and HCV was not seen in any donor. CONCLUSION: So far there is no conclusive evidence that HGV produces hepatitis. But presence of HGV in hepatitis cases casts a doubt on this finding. Prevalence rate in blood donors may be helpful in future studies when the exact role of HGV is known.

Molecular characterization of hepatitis G virus (HGV) isolates from healthy adults and risk groups in the Philippines

Hepatitis G virus (HGV) infection has been detected in Filipinos through a prospective study of 1,088 blood samples. HGV RNA was found in sera of 6/516 (1.2 percent) healthy adults (volunteer blood donors), 11/138 (8.0 percent) chronic liver disease patients, 7/207 (3.4 percent) hemodialysis patients, and 14/227 (6.2 percent) multiply transfused patients using reversetranscription polymerase chain reaction (RT-PCR) with random hexamer primers and a set of PCR primers from the 5 untranslated region (5UTR) of the HGV genome. A total of 38/1,088 subjects were HGV RNA-positiveThe PCR products derived from the 5UTR of HGV RNA+ samples were sequenced to determine the genotypic variant of HGV in the Philippines. Pairwise alignment of sequences and phylogenetic tree construction revealed that among the five known HGV genotypic variants, the Philippine isolates are most closely related to the Asian type (III)Considering that HGV is a highly mutable organism, surveillance for new genotypes may be the only way to assess accurate asymptomatic infection rates. How much this virus evolves in the future may have an impact on its virulence, transmissibility and invasiveness. It is therefore important, from an evolutionary perspective, to continue and monitor evolution of HGV specifically with studies at the molecular level. (Author)