Genotypic distribution & clinical profile of chronic hepatitis B cases: insights from a tertiary care hospital in North India

Background & Objectives India is considered a region with intermediate to high endemicity for the carriage of Hepatitis B surface antigen (HBsAg). Epidemiological updates are crucial to monitor the progress towards the global commitment to eliminate hepatitis by 2030. This study was designed to analyse the demographic, epidemiological, laboratory, virological, clinical, and genotypic characteristics of the patients with Chronic Hepatitis B (CHB) in North India. Methods One hundred and eighty-three HBsAg-positive patients were enrolled in the study between October 2019 and October 2022. Inclusion criteria required patients to have HBsAg detectable in serum for more than six months. The genotype of Hepatitis B virus (HBV) was determined by using polymerase chain reaction (PCR)- based method. To validate the findings, 20 samples were selected for HBV DNA polymerase genes (S/POL) sequencing, which is crucial for accurately classifying of the virus and its genotypic characteristics. Sequences were manually edited with the BioEdit Sequence Editor (version 7.2.5) and analysed via BLAST. Results Among 183 HBsAg-positive chronic liver disease patients, 77.5 per cent clinically presented as HBeAg negative chronic hepatitis. The identified genotypes were predominantly D (170; 92.2%), followed by A (11; 6%) and C (2; 1.1%). Of the total patients, 102 (55.7%) were male, with the majority within the 0-45 years age group (83.4%). The most common risk factor was surgical intervention (77; 42.1%), followed by tattooing and body piercing (39; 21.3%), blood transfusion (14; 7.7%), dialysis (33; 18%), mother-to-child transmission (4; 2.2%), IV drug abuse (10; 5.5%), and dental procedures (3; 1.6%). Familial transmission was observed in 11.8 per cent of spouses. Interpretation & conclusions The study highlighted that genotype D was the most prevalent and acquired commonly through the parenteral routes, with severe disease phase, while genotype A was the next frequent genotype associated with vertical or familial spread, with the most patients seen in the immune-tolerant phase.