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Retrospective analysis of acute HBV infections occurred in 1978–79 and 1994–95 in North-East Italy: increasing prevalence of BCP/pre-core mutants in sub-genotype D3

  • Bruni, Roberto1
  • Villano, Umbertina1
  • Taffon, Stefania1
  • Equestre, Michele1
  • Madonna, Elisabetta1
  • Chionne, Paola1
  • Candido, Angela2
  • Dettori, Stefano2
  • Pisani, Giulio1
  • Rapicetta, Maria1
  • Bortolotti, Flavia3
  • Ciccaglione, Anna Rita1
  • 1 Istituto Superiore di Sanità, Rome, Italy , Rome (Italy)
  • 2 Notified Body 0373, Istituto Superiore di Sanità, Rome, Italy , Rome (Italy)
  • 3 University of Padua, Padua, Italy , Padua (Italy)
Published Article
BMC Infectious Diseases
Springer (Biomed Central Ltd.)
Publication Date
Jan 28, 2020
DOI: 10.1186/s12879-019-4713-9
Springer Nature


BackgroundAt the end of the 1970s, in Italy more than 2% of the general population was HBsAg carrier. In the late ‘70s and late ‘80s, two remarkable events might have impacted on HBV strains transmitted in North-East Italy: (a) the increased HBV incidence due to parenteral drugs between 1978 and 1982; (b) the preventive anti-HIV educational campaign, started locally in 1985.MethodsTo address if those events impacted on circulating HBV variants, acute cases occurred in North-East Italy in 1978–79 (n = 50) and 1994–95 (n = 30) were retrospectively analysed. HBV sequences obtained from serum samples were subjected to phylogenetic analysis and search for BCP/pre-core and S mutations.ResultsHBV-D was the most prevalent genotype in both 1978–79 (43/50, 86%) and 1994–95 (24/30, 80.0%), with HBV-A in all but one remaining cases. Among HBV-D cases, sub-genotype HBV-D3 was the most prevalent (25/29, 86.2% in 1978–79; 13/16, 81.2% in 1994–95), with HBV-D1 and HBV-D2 in the remaining cases. All HBV-A cases were sub-genotype A2.Single and multiple BCP/pre-core mutations, responsible for HBeAg(−) hepatitis, were detected in 6/50 (12%) cases in 1978/79 vs. 12/30 (40.0%) in 1994/95 (p = 0.006). They were found exclusively in HBV-D; in the most abundant sub-genotype, HBV-D3, they were detected in 2/25 (8%) cases in 1978–79 vs. 6/13 (46%) in 1994–95 (p = 0.011). No vaccine escape S mutations were observed. The IDU risk factor was significantly more frequent in 1994–95 (8/30, 26.7%) than in 1978–79 (4/50, 8%) (p = 0.048).ConclusionsThe above mentioned epidemiological and public health events did not affect the proportion of genotypes and sub-genotypes that remained unchanged over 16 years. In contrast, the proportion of BCP/pre-core mutants increased more than three-fold, mostly in HBV-D3, a sub-genotype highly circulating in IDUs; drug abuse likely contributed to the spread of these mutants.The findings contribute to explain a previously described major change in HBV epidemiology in Italy: the proportion of HBeAg(−) cases in the carrier cohort changed from low in late 1970s, to high at the beginning of the 2000s. In addition to other recognized factors, the increased circulation of BCP/pre-core mutants likely represents a further factor that contributed to this change.

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