Natural history of chronic hepatitis B in Euro-Mediterranean and African Countries

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J Hepatol. 2011 Jan 13. [Epub ahead of print]

Natural history of chronic hepatitis B in Euro-Mediterranean and African

Countries.

Hadziyannis S.

Department of Medicine and Hepatology, Henry Dunant Hospital, Athens, Greece.

Abstract

Data derived from population, case-control and cohort studies conducted in

several Euro-Mediterranean and African countries disclose impressive

similarities in the age and modes of hepatitis B virus (HBV) transmission and in

the prevalence, duration and outcome of the four phases of the natural history

of chronic infection. Perinatal HBV infection is rare while the vast majority of

chronic infections originate from horizontal HBV transmission to infants and

children. HBeAg loss and seroconversion to anti-HBe occur in a few years time,

usually during the second decade of life. HBeAg-negative/anti-HBe-positive

chronic hepatitis B (CHB), predominates in these countries being 7-9 times more

frequent than HBeAg-positive CHB. The predominance of HBeAg-negative CHB is

largely linked to the molecular characteristics of HBV genotype D prevailing in

European and African countries of the Mediterranean basin and of genotype E and

subgenotype A1 that prevail in the other parts of Africa. The molecular

characteristics of the African subgenotype A1 differ from those of European

subgenotype A2 explaining the fact that patients infected subgenotype A1

demonstrate an earlier loss of HBeAg and seroconversion to anti-HBe during the

natural course of HBV infection compared to those infected with subgenotype A2.

It is proposed that the molecular characteristics of HBV genotypes and

subgenotypes prevailing in Euro-Mediterranean and African countries acting in

concert with host and environmental factors largely determine the natural

history of chronic HBV infection and its significant differences from countries

of HBV genotype C and B and of subgenotype Ae predominance. The knowledge of the

natural history of chronic HBV infection in Euro-Mediterranean and African

countries combined with wide screening programs for prompt recognition and

treatment of chronic HBV infection both in its HBeAg-positive and -negative

immune reactive phases can be expected to increase the efficacy of current and

future therapeutic strategies.

Copyright © 2011. Published by Elsevier B.V.

PMID: 21238520 [PubMed - as supplied by publisher]