There are nine known subtypes of HBV genotype D (31). HBV subtype D1 is predominant in the Middle East and North Africa, subtype D2 has been found in Albania, Turkey, Brazil, western India, Lebanon, and Serbia, and subtype D3 in Serbia, western India, and Indonesia, especially in people who inject drugs (PWID). Subtype D4 has been rare and has been reported from Haiti, Russia, the Baltic countries, Brazil, Kenya, Morocco, and Rwanda. Subtype D5 is common in eastern India, subtype D6 in Indonesia, Kenya, Russia, and the Baltic region, and subtype D7 in Morocco and Tunisia. Subtypes D8 and D9 have recently been discovered and reported from Niger and India (31).

Background: Hepatitis B virus (HBV) genotypes have been shown to have virological, clinical, and therapeutic implications. Knowledge about HBV genotype distribution in Slovenia is scarce. This study was the first to determine various characteristics of patients with chronic HBV infection with regard to HBV genotypes at the national level. Methods: HBV genotype determination was performed on randomly selected patients out of 1,729 patients from all Slovenian regions who tested positive for HBV surface antigen (HBsAg) at the national reference laboratory for viral hepatitis between January 1997 and December 2010. Demographic, epidemiological, virological, and clinical data were extracted from the medical records and statistically analyzed with regard to HBV genotypes. Results: A total of 186 HBsAg positive patients with the mean age of 40.1 years were identified from whom, 65.1% were male. 157 (84.4%) cases presented with genotype D, 23 (12.4%) with genotype A, and 6 (3.2%) with other HBV genotypes. Sexual transmission was more significantly associated with lower odds for HBV genotype D infection compared to blood-related risk factors (P = 0.023). Genotype A was significantly more common in men who had sex with men (P = 0.043). Compared to females with genotype D, genotype A positive women presented unknown risk factors more significantly (P = 0.002). Conclusions: HBV genotype D is the most prevalent genotype in Slovenia. However, future changes might be expected due to recent massive immigrations to Europe. Routine HBV genotyping is recommended in patients with certain risk factors prior to initiation of hepatitis B treatment.

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