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Genotype-specific Prevalence of Precore and Core Promoter Mutations in HBeAg-negative Chronic Hepatitis B Patients in Iraq. | ||
| Al- Anbar Medical Journal | ||
| Volume 22, Issue 1, January 2026, Pages 41-47 PDF (461.44 K) | ||
| Document Type: Original articles | ||
| DOI: 10.33091/amj.2025.163364.2360 | ||
| Authors | ||
| Huda Salih Jassim1; Mothana Ali Khalil* 1; yasin H Majeed2 | ||
| 1department of microbiology, collage of medicine, university of Anbar | ||
| 2Internal medicine department, collage of medicine, university of Anbar | ||
| Abstract | ||
| 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. | ||
| Keywords | ||
| Hepatitis B virus; Genotype D; Precore mutations; Basal core promoter; HBeAg-negative; Liver fibrosis | ||
| References | ||
|
[1] G. L.-H. Wong and M. Lemoine, "The 2024 updated WHO guidelines for the prevention and management of chronic hepatitis B: Main changes and potential implications for the next major liver society clinical practice guidelines," Journal of Hepatology, vol. 82, no. 5, pp. 918-925, 2025.
[2] R. A. Salih, Z. M. Yassen, and A. B. Al-Dewachi, "Awareness, Attitude, and Practice of Medical Students Towards Hepatitis B Virus Vaccine at University of Mosul, Iraq," Al-Anbar Medical Journal, vol. 20, no. 2, p. 151-157, 2024.
[3] M. D. Ignat et al., "Antiviral therapy of chronic hepatitis B virus between present and future," Journal of clinical medicine, vol. 13, no. 7, p. 2055, 2024.
[4] B. S. Alotaibi, "Hepatitis B virus infection, structure, genotypes, and epidemiology: A review," Pharmacy Practice (Granada), vol. 21, no. 3, p. 23, 2023.
[5] T. B. Sant’Anna and N. M. Araujo, "Hepatitis B virus genotype D: an overview of molecular epidemiology, evolutionary history, and clinical characteristics," Microorganisms, vol. 11, no. 5, p. 1101, 2023.
[6] J.-F. Wu, K.-C. Chang, Y.-H. Ni, H.-Y. Hsu, and M.-H. Chang, "Impacts of the percentage of basal core promoter mutation on the progression of liver fibrosis after hepatitis B e antigen seroconversion," The Journal of Infectious Diseases, vol. 223, no. 8, pp. 1381-1389, 2021.
[7] T. Reuter et al., "Core Promoter and Pre-Core Variants of the Hepatitis B Virus (HBV) Are Frequent in Chronic Hepatitis B HBeAg-Negative Patients Infected by Genotypes A and D," Viruses, vol. 15, no. 12, p. 2339, 2023.
[8] M. Cornberg, F. Tacke, and T. H. Karlsen, "Clinical Practice Guidelines of the European Association for the study of the Liver–Advancing methodology but preserving practicability," Journal of hepatology, vol. 70, no. 1, pp. 5-7, 2019.
[9] A. S. K. Al-Suraifi, A. D. J. Al-Rubaie, S. M. G. Al-Mayahie, and N. M. M. Al-Abedy, "Unusual HBV mixed genotype infections among hepatitis type b Iraqi patients in Wasit province/Iraq," Int J Biomed Eng Clin Sci, vol. 2, no. 1, pp. 1-7, 2016.
[10] Z. K. Gataa, N. B. AL-Awadi, and S. S. Ejam, "Association of Hepatic Fibrosis Measured by Transient Elastography with Ferritin Level of Patients with Transfusion Dependent Thalassemia in Iraq," Al-Anbar Medical Journal, vol. 21, no. 3, p. 206-211, 2025.
[11] M. Nakhaie et al., "Hepatitis B Virus (HBV) and Occult Hepatitis B Virus (OBI) in Hemodialysis Patients: An Epidemiological Observational Study in Kerman, Iran (2022-2023)," Iranian Journal of Medical Microbiology, vol. 17, no. 6, pp. 646-653, 2023.
[12] A. A. Al-Qahtani et al., "Molecular epidemiology, phylogenetic analysis and genotype distribution of hepatitis B virus in Saudi Arabia: Predominance of genotype D1," Infection, Genetics and Evolution, vol. 77, p. 104051, 2020.
[13] M. Sayan and C. Dogan, "Genotype/subgenotype distribution of hepatitis B virus among hemodialysis patients with chronical hepatitis B," Annals of hepatology, vol. 11, no. 6, pp. 849-854, 2012.
[14] N. Khodadad et al., "In silico functional and structural characterization of hepatitis B virus PreS/S-gene in Iranian patients infected with chronic hepatitis B virus genotype D," Heliyon, vol. 6, no. 7, 2020.
[15] M. Norouzi et al., "Hepatitis B virus genotype D is the only genotype circulating in Iranian chronic carriers, the unique pattern of genotypic homogeneity," J Gastroenterol Hepatol Res, vol. 3, no. 9, pp. 1238-43, 2014.
[16] A. Schollmeier, M. Basic, M. Glitscher, and E. Hildt, "The impact of HBx protein on mitochondrial dynamics and associated signaling pathways strongly depends on the hepatitis B virus genotype," Journal of virology, vol. 98, no. 5, pp. e00424-24, 2024.
[17] N. M. Araujo, S. A. Teles, and N. Spitz, "Comprehensive analysis of clinically significant hepatitis B virus mutations in relation to genotype, subgenotype and geographic region," Frontiers in microbiology, vol. 11, p. 616023, 2020.
[18] A. Kaewdech, P. Charatcharoenwitthaya, and T. Piratvisuth, "Asian perspective on hepatitis B virus and hepatitis C VIRUS ELIMINATION," Viruses, vol. 17, no. 1, p. 34, 2024.
[19] M. M. Ratnaparkhi, C. R. Vyawahare, and N. R. Gandham, "Hepatitis B virus genotype distribution and mutation patterns: Insights and clinical implications for hepatitis B virus positive patients," World Journal of Experimental Medicine, vol. 15, no. 2, p. 102395, 2025.
[20] O. A. Sobajo et al., "Detection of Immune Escape and Basal Core Promoter/Precore Gene Mutations in Hepatitis B Virus Isolated from Asymptomatic Hospital Attendees in Two Southwestern States in Nigeria," Viruses, vol. 15, no. 11, p. 2188, 2023.
[21] A. Mahajan, S. Kharawala, S. Desai, S. Kendrick, J. Das, and V. Gielen, "Association of Hepatitis B Surface Antigen Levels With Long‐Term Complications in Chronic Hepatitis B Virus Infection: A Systematic Literature Review," Journal of Viral Hepatitis, vol. 31, no. 11, pp. 746-759, 2024.
[22] C. Saitta, T. Pollicino, and G. Raimondo, "Occult hepatitis B virus infection: an update," Viruses, vol. 14, no. 7, p. 1504, 2022.
[23] W. H. Organization, Global hepatitis report 2024: action for access in low-and middle-income countries. World Health Organization, 2024.
[24] B. K. Kim, "Future Perspectives of Liver Research in the Asia‐Pacific Region: Focus on Hepatitis B and C," Journal of Gastroenterology and Hepatology, 40:1855–1860, 2025.
[25] A. Kramvis, "Molecular characteristics and clinical relevance of African genotypes and subgenotypes of hepatitis B virus," SAMJ: South African Medical Journal, vol. 108, no. 8, pp. 17-21, 2018.
[26] L. Cao, L. Li, L. Yang, N. Zhou, and Y. Zhang, "Efficacy and safety of tenofovir and entecavir in patients with chronic hepatitis B-related cirrhosis: a systematic review and meta-analysis," Frontiers in Pharmacology, vol. 16, p. 1507117, 2025.
[27] X. Yu et al., "Hepatitis B: Model Systems and Therapeutic Approaches," Journal of Immunology Research, vol. 2024, no. 1, p. 4722047, 2024.
[28] M. Chakraborty, M. K. Gupta, S. Butta, and H. Banu, "Comparison of Basal Core Promoter Region Mutation and Precore Mutation among Monoinfected Hepatitis B Virus and Coinfected Hepatitis B Virus with Human Immunodeficiency Virus Patients," J Assoc Physicians India, vol. 72, no. 12, pp. 18-21, 2024.
[29] A. Liguori, M. Zoncapè, G. Casazza, P. Easterbrook, and E. A. Tsochatzis, "Staging liver fibrosis and cirrhosis using non-invasive tests in people with chronic hepatitis B to inform WHO 2024 guidelines: a systematic review and meta-analysis," The Lancet Gastroenterology & Hepatology, 10(4):332-349, 2025.
[30] A. A. Rabaan et al., "The Dual Burden of Hepatitis B and C Among Drug Users in Asia: The First Systematic Review and Meta-Analysis," Pathogens, vol. 14, no. 4, p. 360, 2025.
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