BackgroundHepatitis B virus (HBV) is a blood-borne hepatotrophic virus and a major causative agent of liver disease. The virus is highly endemic in African countries, and five genotypes (A–E) have been identified. This study aimed to establish the most prevalent genotypes of HBV among liver disease patients from different geographical regions of Eritrea, an East African multi-ethnic country.MethodsThis study included 293 Eritrean liver disease patients who were hepatitis B surface antigen (HBsAg)-positive. Enzyme-linked immunosorbent assay (ELISA)-based serological screening and multiplex-nested PCR using type-specific primer-based genotyping were performed to determine the prevalence of genotypes in the Eritrean population.ResultsThe mean (± standard deviation) age was 41.66 ± 13.84 years; 213 (72.7%) patients were males and 80 (27.3%) were females. The median (interquartile range) of HBV DNA and alanine aminotransferase levels were 3.47 (1.66) log IU/ml and 28 (15.3) IU/L, respectively. All patients’ sera were HBsAg- and anti-HBc-total positive; 20 (6.8%) were HBeAg-positive/anti-HBe-negative, 242 (82.6%) were HBeAg-negative/anti-HBe-positive, and 31 (10.6%) had neither HBeAg nor anti-HBe according to the ELISA screening test. Of the 293 patients, only 122 (41.6%) were positive for HBV DNA, 57.38% had a single genotype, and 42.62% had a mixed HBV genotype infection. Irrespective of mode of occurrence, HBV genotype D (n = 26; 21.3%) was the predominant circulating genotype, followed by genotypes C (n = 21; 17.2%), E (n = 19; 15.6%), C/D (n = 16; 13.1%), and C/E (n = 13; 10.7%). Genotypes C/D/E (n = 9; 7.4%), A/D (n = 6; 4.9%), D/E (n = 5; 4.1%), A (n = 3; 2.5%), and B, A/E, B/E, and A/D/C (each with n = 1; 0.8%) were also present.ConclusionHBV in Eritrea is comprised of a mixture of genotypes A, B, C, D, and E separately or in combinations. Our findings demonstrated that in Eritrea, the most prevalent HBV genotype in Eritrea is genotype D among theliver disease patients with higher HBeAg positivity. This is the first study of HBV genotyping based on PCR methods in Eritrea.