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mutations in acute hbv ultradeep sequence, only tenofovir looks very safe
A COMPLEX HBV QUASISPECIES IN RT AND HBSAG CHARACTERIZES PATIENTS WITH ACUTE HEPATITIS B: A REFINED UDPS ANALYSIS Print

M. Aragri1, N. Coppola2, C. Alteri1, C. Minichini2, A. Battisti1, C. Sagnelli3, M.C. Bellocchi1, M.A. Pisaturo2, R. Salpini1, M. Starace2, F. Continenza4, D. Armenia1, L. Carioti1, M. Pollicita1, E. Sagnelli2, C.F. Perno1,5, V. Svicher1
1Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, 2Department of Mental Health and Public Medicine, 3Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, Naples, 4I.N.M.I. L. Spallanzani, 5Tor Vergata University Hospital, Rome, Italy
E-mail: marianna.***@****

Background and aims: To investigate HBV-RT and HBsAg genetic heterogeneity in patients with acute hepatitis B (AHB) in Italy.
Methods: This study included 44 HBsAg+ and IgM/anti-HBc+ patients with a compatible clinical-history for AHB (all genotype-D) observed from 2000 to 2010. Plasma-samples obtained at the first-observation were used for population- and ultra-deep sequencing (UDPS). Immune-escape mutations were retrieved from literature.
Results: 68.2% of patients was male with median (IQR) age of 34 (27-46) years. Median (IQR) ALT and median (IQR) serum HBV-DNA were 2,717(2,035-3,319)U/L and 5.2(IQR:4.5-6.9)log10IU/ml.No drug-resistance mutation was identified by population-sequencing. Conversely, UDPS detected >1 drug-resistance mutation (rtA181T/A181V/rtM204I/rtA194T/rtT184A) in 13.6% of patients with an intra-patient prevalence ranging from 0.02% for rtA181V to 47.5% for rtA181T, both associated with suboptimal nucleotide-analogues (mostly adefovir) response. By UDPS analysis, 29.5% of patients carried >1 immune-escape mutation within the a-determinant (intra-patient prevalence from 0.84% to 100%). Although no patients received HBV-vaccination, sG145R (known to act as vaccine-escape) was detected in 2 patients with an intra-patient prevalence of 3.9% and 99.9%. Stop-codons were found in 15.9% patients (intra-patient prevalence range:1.6%-47.5%). They occurred at 5 HBsAg-positions including positions 172 and 182 known to correlate with an increased HBV oncogenic-potential.
Conclusions: A viral-quasispecies with reduced antigenicity, altered drug-susceptibility, and/or with enhanced oncogenic-potential characterizes a large fraction of AHB-patients. These viral-variants may potentially expose patients to severe and/or difficult-to-treat forms of HBV-infection, and may affect the efficacy of current HBV-vaccination strategy.


Assigned speakers:
Marianna Aragri , University of Rome Tor Vergata , Rome , Italy

Assigned in sessions:
11.04.2014, 09:00-18:00, Poster, 7B - VIRAL HEPATITIS: HEPATITIS A, B, D E CLINICAL (EXCEPT THERAPY), Poster Exhibition
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Avatar universal
Do you know if all acute cases in this study cleared? Also what was the Tenofovir result, it was cut off in your title
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they all cleared the study  is about quasispieces of hbv by ultradeep sequence

tenofovir is just my opinion, if hbv has all these mutations baseline on its own only an antiviral with no resistance is really 100
% safe on this
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i mean not tenofovir for them, they cleared, for all infected, if we check ultradeep i think we find all mutations to lam and adv already present
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