Background & Aims
Replication markers exhibit substantial variation during chronic hepatitis B virus (HBV) infection, part of which can be explained by mutations on the surface (S) gene. We aimed to identify S‐gene mutations possibly influencing the quantification of HBV replication markers (MUPIQH) in HBV genotype E infection, common to Western Africa.
Methods
Seventy‐three antiretroviral treatment (ART)‐naïve human immunodeficiency virus (HIV)‐HBV co‐infected patients from Côte d'Ivoire, initiating anti‐HBV‐containing ART, had available HBV S‐gene sequences. S‐gene MUPIQHs were screened at ART initiation based on lower HBV‐DNA or HBsAg quantification (qHBsAg) compared to wildtype. Their association with HBV virological response and qHBsAg slope during treatment was evaluated.
Results
Genotype E was predominant (95.9%). At ART initiation, median HBV‐DNA was 7.27 log10 copies/mL (IQR = 5.26‐8.33) and qHBsAg 4.08 log10 IU/mL (IQR = 3.49‐4.61). Twelve S‐gene MUPIQHs were identified among 21 patients (28.8%): sS140L (n = 4), sD144A (n = 1), sS167L (n = 2), sS174N (n = 6), sP178Q (n = 2), sG185L (n = 2), sW191L (n = 2), sP203Q/R (n = 2), sS204N/I/R/K/T/G (n = 7), sN207T (n = 2), sF212C (n = 1) and sV224A/Y (n = 7). MUPIQHs at positions s185+s191+s224 and s178+s204 were within highly covarying networks of S‐gene mutations. Older age (P = 0.02), elevated transaminases (P = 0.03) and anti‐hepatitis B “e” antibody‐positive serology (P = 0.009) were significantly associated with prevalent MUPIQHs at ART initiation. During treatment, baseline MUPIQHs were not associated with time‐to‐undetectable HBV‐DNA (P = 0.7) and qHBsAg levels decreased at similar rates between those with vs without MUPIQHs (P = 0.5).
Conclusion
Several novel S‐gene mutations were associated with reductions in replication markers among West African co‐infected patients. These mutations, however, do not affect response during antiviral treatment. Their diagnostic and clinical consequences need clarification.