Disproportionate Distribution of HBV Genotypes A and D and the Recombinant Genotype D/E in the High and Low HBV Endemic Regions of Uganda: A Wake-Up Call for Regional Specific HBV Management

Hussein Mukasa Kafeero; Dorothy Ndagire; Ponsiano Ocama; Charles Drago Kato; Eddie Wampande; Henry Kajumbula; David Kateete; Abdul Walusansa; Ali Kudamba; Kigozi Edgar; Fred Ashaba Katabazi; Maria Magdalene Namaganda; Jamilu E Ssenku; Hakim Sendagire

doi:10.1155/2022/3688547

Disproportionate Distribution of HBV Genotypes A and D and the Recombinant Genotype D/E in the High and Low HBV Endemic Regions of Uganda: A Wake-Up Call for Regional Specific HBV Management

Int J Hepatol. 2022 Jan 11:2022:3688547. doi: 10.1155/2022/3688547. eCollection 2022.

Authors

Hussein Mukasa Kafeero^{1

2}, Dorothy Ndagire³, Ponsiano Ocama⁴, Charles Drago Kato⁵, Eddie Wampande⁵, Henry Kajumbula¹, David Kateete⁶, Abdul Walusansa^{2

3}, Ali Kudamba^{7

8}, Kigozi Edgar⁶, Fred Ashaba Katabazi⁶, Maria Magdalene Namaganda⁶, Jamilu E Ssenku^{3

8}, Hakim Sendagire^{1

2}

Affiliations

¹ Department of Microbiology, Makerere University, College of Health Sciences, P. O. Box 7062, Kampala, Uganda.
² Department of Medical Microbiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda.
³ Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
⁴ Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
⁵ Department of Biomolecular Resources & Biolab Sciences (BBS) College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Makerere University, P.O. Box 7062, Kampala, Uganda.
⁶ Department of Molecular Biology and Immunology, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
⁷ Department of Physiology, Habib Medical School, Faculty of Health Sciences, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda.
⁸ Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, P.O. Box 2555, Mbale, Uganda.

Abstract

Background: Hepatitis B virus (HBV) is the leading cause of liver-related diseases. In Uganda, there is a regional disparity in the HBV burden. Our study was aimed at establishing the circulating genotypes in a low and a high endemic region to give plausible explanations for the differences in regional burden and guide the future management of the disease.

Methods: A total of 200 HBsAg-seropositive subjects were recruited into the study by convenience sampling. The HBsAg Rapid Test Strip (Healgen Scientific Limited Liability Company, Houston, TX77047- USA) was used to screen for HBsAg while the Roche machine (Roche, Basel Switzerland/Abbot Technologies (USA)) was used to determine the viral load. The Chemistry Analyzer B120 (Mindray, China) was used for chemistry analysis. For HBV genotyping, total DNA was extracted from whole blood using the QIAamp® DNA extraction kit. Nested PCR amplification was performed using Platinum Taq DNA Polymerase (Invitrogen Corporation, USA) to amplify the 400 bp HBV polymerase gene. Purification of nested PCR products was performed using Purelink PCR product purification kit (Life Technologies, USA). Automated DNA sequencing was performed using BigDye Terminator v3.1 Cycle Sequencing Kit on 3130 Genetic Analyzer (Applied Biosystems, USA). The NCBI HBV genotyping tool (https://www.ncbi.nlm.nih.gov/projects/genotyping/formpage.cgi) was used for determination of genotype for each HBV sequence. Pearson's chi-square, multinomial logistic regression, and Mann-Whitney U tests were used for the analysis. All the analyses were done using SPSS version 26.0 and MedCalc software version 19.1.3 at 95% CI. A p < 0.05 was considered statistically significant.

Results: Majority of our study subjects were female (64.5%), youth (51.0%), and married (62.0%). Overall, genotype A was the most prevalent (46%). Genotype D and the recombinant genotype D/E were proportionately more distributed in the high endemic (38.2%) and low endemic (36.5%) regions, respectively. Genotype D was significantly more prevalent in the high endemic region and among the elderly (p < 0.05). Genotype D was significantly associated with elevated viral load and direct bilirubin (p < 0.05). The recombinant genotype D/E was significantly associated with elevated viral load (p < 0.05). Similarly, genotype A was significantly associated with elevated AST and GGT, lowered viral load, and normal direct bilirubin levels (p < 0.05).

Conclusion: There is disproportionate distribution of genotypes A and D and the recombinant genotype D/E in the low and high endemic regions of Uganda. This probably could explain the differences in endemicity of HBV in our country signifying the need for regional specific HBV management and control strategies.