1
Institute of Virology, University Hospital of Essen, University of Duisburg, Essen, Germany.
2
Department of Gastroenterology and Hepatology, University Hospital of Essen, Germany.
3
Department of Gastroenterology and Hepatology, University Hospital of Magdeburg, Germany.
4
Department of Molecular and Medical Virology, Ruhr University, Germany.
5
Institute of Virology, University Hospital of Düsseldorf University of Düsseldorf, Germany.
Abstract
INTRODUCTION:
Acute hepatitis B virus (HBV) infection remains a frequent cause of acute liver failure (ALF) worldwide. ALF occurs in 0.1-0.5% of infected patients. Aim of this study was to scrutinize the outcome of patients with HBV induced ALF and mutational patterns of HBV variants, which might contribute to ALF.
METHODS:
From 2005 to 2016, 42 patients were treated for HBV-induced ALF in the University Hospital Essen, Germany. Clinical and virological data from these patients were collected. As a control, 38 patients with acute hepatitis B (AHB) without liver failure were included. The HBV genome was sequenced by Next Generation Sequencing (NGS). Mutations that were found by NGS were analyzed in vitro.
RESULTS:
8/42 patients had ALF without spontaneous recovery (NSR): 7 patients underwent liver transplantation (LTx) and one patient died before LTx. 34/42 patients (81%) had spontaneous recovery (SR) and cleared the infection, achieving either anti-HBs seroconversion or HBsAg loss. HBV genotype (GT)-D was the most frequent GT in ALF patients. Mutations in HBV core, preS2 and SHB (small hepatitis B surface antigen) were more frequent in patients with ALF -non spontaneous recovery (NSR) compared to ALF-spontaneous recovery (SR) or AHB patients. Amino acid deletions (16-22 and 20-22) in preS2 and SHB mutation L49R were exclusively detected in ALF-NSR patients. In vitro analyses reveal that these mutations did not influence HBsAg secretion or infectivity.
CONCLUSIONS:
HBV GT-D and increased variability in HBV core, preS2 region and SHB are associated with a worse clinical outcome of acute HBV infection. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: