Hepatitis B genotype D profile: Clinical presentations, fibrosis status, gene mutation, and HBe Ag expression in chronic HBV patients

Background: HBV genotypes are associated with differences in the severity of underlying liver disease and genes mutation. Being the commonest HBV genotype in Egypt we studied the characteristics of HBV genotype D regarding the clinical presentations, gene mutations and fibrosis status. Methods: 100 chronic HBV genotype D patients studying the baseline characteristics, hepatic fibrosis, BCP, pre-core gene mutation and HBeAg status. Results: 76% of the patients were under 40 years. ALT and AST were within normal ranges in 63% and 71% respectively and HBV PCR > 20000 IU/ML in 65%. Advanced fibrosis (> F2) was present only in 11% associated with older age (>40years), elevated ALT and AST, viral load (p value = 0.038, 0.014, <0.001 and 0.006 respectively). 62% of patients were HBeAg negative disease, pre-core mutation was detected in 62 patients, 17 patients with BCP mutation and 10 patients carried both pre-core and BCP mutations. No relation detected between the viral load (p = 0.630), progression of fibrosis (p= 0.52) and HBeAg status. No relation with the viral load and serum transaminases and the BCP gene mutations. Conclusion: HBV genotype D is associated with HBV chronic inactive state rather than acute hepatitis and active infection. Advanced fibrosis is less observed in genotype D patients increasing with age and associated with elevated enzymes and high viral load. HBeAg negative disease is highly expressed and pre-core mutation more observed than BCP mutation. No relation between the progression of fibrosis, viral load and HBeAg expression and BCP gene mutation.