Genotype-specific Prevalence of Precore and Core Promoter Mutations in HBeAg-negative Chronic Hepatitis B Patients in Iraq.

Background: The distribution of hepatitis B virus (HBV) genotypes and viral mutations significantly influences disease progression in HBeAg-negative chronic hepatitis B (CHB), particularly in endemic regions where molecular epidemiological data are limited. Objectives: To assess the molecular epidemiology of HBV in Iraqi patients with HBeAg-negative chronic hepatitis B, focusing on genotype prevalence, key precore (G1896A, G1898A) and basal core promoter (A1762T, G1764A) mutations, and their prognostic significance for advanced hepatic disease. Results: Genotype D predominated (85.3%), exhibiting significantly elevated viral loads compared to non-D genotypes (4.9±1.3 vs. 4.3±1.0 log I. U/mL, P-value = 0.02). G1896A mutation prevalence reached 54.7% overall, with marked elevation in genotype D patients (61.7% vs. 20.0% in genotype C, P-value = 0.004). Advanced fibrosis (F3-F4) was observed in 36.7% of patients, with G1896A mutation (OR=3.1, 95% CI: 1.4-6.9) and BCP mutations (OR=4.3, 95% CI: 1.9-9.8) serving as independent predictors. Laboratory parameters, including albumin levels <3.5 g/dL and platelet counts <150×10³/μL, demonstrated strong associations with the development of cirrhosis. Conclusion:  HBV genotype D and associated precore mutations are significant predictors of severe clinical outcomes in Iraqi HBeAg-negative CHB patients, supporting integrated molecular diagnostics for enhanced risk stratification in resource-limited settings.