Hepatitis B Virus Genotype Distribution and Virological Profiles in a Canadian Immigrant Cohort

Introduction: Hepatitis B virus (HBV) genotypes exhibit distinct geographic distributions and may differ in virological expression. In low-endemic settings such as Canada, where chronic HBV burden is largely migration-driven, clinical cohorts provide a unique opportunity to characterize genotype diversity and its relationship with sociodemographic and baseline virological markers. Methods: We conducted a retrospective cohort study of patients with chronic HBV infection and available genotype results followed in The Ottawa Hospital Viral Hepatitis Program (TOHVHP) between 2001 and 2025. Results: Among 778 patients (median age 42.5 years; 52.3% male), 94.3% were born outside Canada, representing 78 countries and predominantly Asian (51.4%) and Black (34.8%). Six genotypes were identified: A (19.8%), B (25.6%), C (21.0%), D (17.4%), E (15.9%), and F (0.4%). Distribution reflected global migration patterns, with B/C predominating in East and Southeast Asia, E in West Africa, A in East Africa and the Caribbean, and D across the Middle East and North Africa, South Asia, and Europe/Central Asia. Younger age was observed among African-associated genotypes and among Black and Arab/MENA populations. Genotype-ethnicity patterns were concordant (A/E predominantly Black; B/C > 95% Asian; D heterogeneous). Genotypes B and C were independently associated with higher HBV DNA compared with genotype A. Overall, 10.7% of patients were HBeAg-positive, with genotype C showing the highest prevalence (23.7%) and an independent association with HBeAg positivity (aOR 8.3, 95% CI 2.0–34.9). Younger age and male sex were associated with higher HBV DNA and HBeAg positivity. Conclusions: In this immigration-rich Canadian cohort, HBV genotype distribution closely reflected global epidemiology and was strongly structured by country and region of birth. Baseline virological activity also differed by genotype and host factors, supporting integration of HBV genotype with sociodemographic context when characterizing chronic HBV in diverse migrant-receiving populations.