الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
HBV is a serious public health problem worldwide and major cause of chronic
hepatitis, cirrhosis, and HCC. It was estimated that approximately 2 billion people have
serological evidence of past or present HBV infection. More than 350 million are chronic
carriers of HBV.
(14)
Eight genotypes of HBV worldwide have been identified. When sequencing the
entire viral genome, these genotypes differ from each other by more than 8%. In addition,
multiple sub-genotypes have been and are continued to be identified, which differ from
each other by 4–8%. The HBV genotypes identified todate are A, B, C, D, E, F, G, and H.
This study was carried out during the period between 2013- 2014. It included 84
HBs Ag positive patients admitted to Alexandria Fever Hospital, and aimed to determine
the genotypes of HBV in chronic hepatitis B patients in Alexandria Governorate – Egypt
and to correlate clinical, biochemical and virological data with HBV genotypes.
All relevant information was collected from each patient including personal data as
(age, sex, etc) as well as health data (history of blood transfusion, anti Schistosomal
treatment, and previous surgical interference).
Blood samples were collected from all patients, left to clot. Serum was separated by
centrifugation at 1500 revolution per minute (rpm) then stored in small aliquots at -20°C
for further investigation. Sera were tested for thefollowing investigations:
1) Biochemical studies (determination of serum alanineaminotransferase).(224)
2) Detection of antibodies against Hepatitis Be antigen (anti-HBe).
3) Detection of Hepatitis Be antigen (HBe Ag).
4) Detection of HBV-DNA by Real Time PCR (Artus).
(225)
5) Detection of HBV-DNA by Nested PCR using specific primers for polgenes.
(226)
6) Detection of HBV genotypes by Sequencing.
Out of the 84 HBsAg positive patients included in this study 66 (78.5%) were males
while 18 (21.43%) were females and 27 (32.1%) of the studied patients were below 30
years of age.
Among the 84 HBsAg Positive patients the highest risk factor was surgical
operations (22.6%) followed by a history of antibilharzial treatment (14.3%).
Among the 84 HBsAg positive Patients 26 ( 31%) werepositive for HBeAg and 58
(69%) were anti-HBe positive. Viral load ranging from > 10
8
to 10
6
IU/ml was associated
with HBe positivity and lower viral load ranging from 10
5
to less than 10
2
was associated
with anti HBe positivity.
Of the HBe Ag positive patients 9 (34.7%) were below 30 years of age while 11 (
42.3%) of them were in the age of 40-50 years and that the majority 39 (67.2%) of the 58
anti HBe positive were below 40 years.
Among the 84 HBsAg positive patients 33.3% (28 patients) were positive for Pol
gene by Conventional Nested PCR. Of these 28 patients 26 (92.6%) were HBeAg positive
while only 2 (7.4%) were anti-HBe positive. Moreover, 6 (23.1%) of the 26 HBe Ag
positive patients showed elevated (ALT ) level while only 7 ( 12.1%) of the 58 anti HBe
positive patients show elevated (ALT) level.
The 26 HBe Ag positive patients had a viral load higher than 20,000 IU/ml, only 6
(23%) of them had elevated (ALT) level. Out of the 58 anti HBe positive patients 23 had a
viral load below 2000 IU/ml, 91.3% of them had normal ALT values, while 20 had a viral
load ranging from ( 2000 to < 20,000) 80% of them had normal ALT level.On the other
hand 15 had a viral load ( ≥ 20.000) 93.3% of them had normal ALT level.
Among the 84 HBsAg positive patients only 21 (25%) could be considered as
inactive carrier (viral load below 2000 IU/ml and normal ALT level) while 16 (19%) were
need follow up (with a viral load ranging from 2000to <20,000 and normal ALT level).
On the other hand about 47 (55.9%) are considered as chronic HBVcases.
The amplification of pol gene was associated with ahigh viral load, ranging from 10
5
to > 10
8
IU/ml. The 28 pol gene positive cases were sequenced and all were genotyped as
HBV genotype D.
In conclusion The results of the present study showed that in Alexandria, Egypt the
prevalent HBV genotype is genotype D which is in accordance with previous published
data.