Detection of Hepatitis B Virus Variants in HBV Monoinfected and HBV/HIV Coinfected Iranian Patients Under Lamivudine Treatment

Mohammad      Reza Aghasadeghi; Golnaz      Bahramali; Seyed      Mehdi Sadat; Ahmad      Farahani Far; Minoo      Mohraz; Seyed      Davar Siadat; Ehsan      Mostafavi; Arash      Memarnejadian; Mehdi      Shafiee Ardestani; Rouhollah      Vahabpour; Alireza      Azizi Saraji; Seyed      Ali Delbaz

Abstract

Chronic hepatitis B affects nearly 10% of HIV-infected patients. Hepatitis B virus (HBV) infection is a dynamic disease and coinfection with HIV impacts directly on the outcome of HBV infection, considerably complicating its natural history, diagnosis, and management. The aim of this study was to compare two cohorts of HBV monoinfected and HBV/HIV coinfected Iranian patients undergoing long-term lamivudine therapy from the clinical and virological aspects, as well as the frequency of detected mutations in HBV genome. To this end, HBV Pol/S regions from 72 patients were PCR-amplified and directly sequenced. Phylogenetic analysis indicated a 40-times higher risk of coinfection with ayw3 subtype of HBV genotype D rather than ayw2 subtype [P < 0.001, odd: 40.66, CI: 95% (4.69-352.23)]. While no resistance mutation was detected in HBV/HIV coinfected cohort, LAM-resistance mutations (rtM204I/V in YMDD and rtL180M in FLLA polymerase motifs) were identified in 30% (9 out of 30) and 16.66% (5 out of 30) of HBV monoinfected patients (P < 0.05). Moreover, several mutations (sP105A, sI110S/L, sS136Y and sP127T/L) with significant differences in the frequency were identified in the S region of both cohorts. Finally, this study found strong correlation between the type of infection (mono or coinfection) and characteristics like patient gender, ALT levels, HBV-DNA levels and HBV subtypes. These results pointed to the importance of determination of HBV variants in the management of patients and suggested that in contrary to HBV monoinfections, LAM may be still an appropriate drug for the treatment of HBV in HBV/HIV coinfected patients; however, further studies to clarify the role of HIV in HBV LAM-resistance mutations are required..

Keywords: HBV, HIV, mono/coinfection, lamivudine, mutation, Iran, HBV/HIV, HBV-DNA level, YMDD+FLAA, LAM therapy