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Precore and basal core promoter mutations in Asian American patients with hepatitis B e antigen‐positive chronic hepatitis B
Author(s) -
Vutien P.,
Trinh H. N.,
Nguyen K.,
Garcia R. T.,
Nguyen H. A.,
Levitt B. S.,
Nguyen L.,
Ha N. B.,
Ahmed A.,
Daugherty T.,
Garcia G.,
Nguyen M. H.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12193
Subject(s) - medicine , hbeag , hepatitis b virus , hepatitis b , virology , genotype , immunology , gastroenterology , virus , hbsag , biology , gene , genetics
Summary Background Prior studies have shown that precore mutations abolish and basal core promoter ( BCP ) mutations down‐regulate hepatitis B e antigen ( HB eAg) production. Thus, the presence of precore and BCP mutations in HB eAg‐positive patients indicates an infection with a mixed viral population of wild‐type and precore and/or BCP mutant hepatitis B virus ( HBV ). To date, there has been limited study of the prevalence and clinical significance of precore and BCP mutations in patients with HB eAg‐positive chronic hepatitis B. Aim To determine the prevalence, predictors and clinical characteristics of mixed wild‐type and precore/ BCP HBV infection, through a cross‐sectional study, in a US cohort of patients with chronic hepatitis B. Methods We conducted a retrospective study of 828 chronic hepatitis B patients with HBV genotype and mutation panel testing seen at three US gastroenterology and liver clinics from June 2005 to September 2009. Results A majority of our patients (92.3%) were either Vietnamese or Chinese American. In the HB eAg‐positive cohort, 17% of patients had precore mutations only, 28% had BCP mutations only and 5% had both BCP and precore mutations. On multivariate analyses, HBV genotype C, increasing age, lower HBV DNA level and an ALT quotient >2 were independent predictors for the presence of precore and/or BCP mutations. Conclusions The current distinction and management recommendations for HB eAg‐positive vs. HB eAg‐negative patients with chronic hepatitis B should be reassessed. Additional biomarkers and treatment endpoints should be studied for their usefulness in predicting continued viral suppression after treatment discontinuation.