Background & objectives: There is a paucity of information on distribution of hepatitis B genotypes from northeastern part of India. Arunachal Pradesh, one of the northeastern State of India bordering Bhutan, China and Myanmar, reported abnormally high numbers of hepatitis B surface antigen (HBsAg) positive cases in one of its districts during January-June 2005. We conducted this study in the subsequent months (August-December 2005) to know the prevalent genotypes by a rapid and specific method based on type-specific primers in Upper Dibang valley of Arunachal Pradesh.
Methods: A total of 438 randomly selected individual were screened for HBsAg positivity. Of the 93 HBsAg positive individuals, 36 HBsAg and HBV DNA positive samples were processed for HBV genotyping using type-specific primer based nested PCR (TSP-PCR). Representative samples were retested with RFLP-PCR based genotyping and nucleotide sequencing.
Results: Of the 36 samples, 29 (80.1%) could be genotyped by the TSP-PCR based method used. The predominant genotype was genotype A (41.6%) followed by genotypes C (27.8%) and D (11.1%). Seven isolates (19.9%) could not be genotyped by this method.
Interpretation & conclusions: The presence of genotype C in this part of the country needs attention as genotype C takes a more aggressive disease course. Also, detection of genotype C in this isolated community bordering Tibet suggests viral gene flow from Tibet or other South-east Asian countries where genotype C of HBV is predominant.
Key words Arunachal Pradesh - genotype C - hepatitis B - HBV
Hepatitis B virus (HBV) is a major public health problem with over 360 million chronically infected people worldwide and accounting for about 600,000 deaths from HB V-related liver disease or hepatocellular carcinoma annually1. Though a safe and effective vaccine has been available for more than 20 yr, it is not effective for established infections. Recently, HBV genotypes have attracted increasing attention since they influence the activity and outcome of HBV-associated chronic liver disease, as well as the response to antiviral therapies2.
There is paucity of data regarding HBsAg prevalence of HBV in north east (NE) India. There are pockets of high HBsAg cases especially among the isolated tribal communities in India3,4. An isolated tribal region situated at an altitude of over 1800 meters above sea level in Arunachal Pradesh bordering Tibet was investigated during August-December 2005 and the prevalent genotypes were characterized. The Idu Mishimi tribe of Arunachal Pradesh mostly inhabits this region. Idu tribe migrated from Tibet long back. HBV genotype C and C/D hybrids are common in Tibet5. However, genotypes A and D are predominant in India6, so we studied this remote tribal community for genotype distribution.
The main objective of the study was to know the circulating genotypes of HBV in this remote tribal community of the northeast, as no data were available on the prevalent HBV genotypes.
Material & Methods
The study was conducted between August to December 2005 and samples were collected from subjects enrolled for the study from Anini, the district headquarter of Upper Dibang valley of Arunachal Pradesh. Upper Dibang valley with an area of 9000 sq km has roughly a person per sq km with an approximate native population of 7152 (as per 2001 census) of mostly Idu Mishmi’s, including Anini, which has an approximate four thousand local residents. The route of this Mongoloid tribe can be traced to the Lhoba tribe of Tibet and they migrated to India long back and have remained a closed community for several centuries.
The study protocol was approved by the ethical committee of Regional Medical Research Centre, Dibrugarh. A total of 438 randomly selected individuals from the community between 2 to 56 yr (to cover approximately 4 per cent of world’s Idu Mishimi populations) with unknown HBsAg status were screened for HBsAg (EQUIPAR HBs Ag ELISA kits, Italy); and interviewed after obtaining a written and informed consent, and documented in a structured questionnaire to record the demographic information and clinical history. Non tribals were excluded from the study. Venous blood (5 ml) was withdrawn in a K3 EDTA tube from each person and plasma was separated, transported and preserved at -20CC till analyzed. From the 93 HBsAg positive samples, randomly 36 HBsAg and HBV DNA positive samples were processed for HBV genotyping.
DNA was extracted from 100 ìÀ of plasma using a commercial blood DNA extraction kit (E.Z.N.A. Blood DNA kit, Omega Bio-tek, USA).
The strategy described by Naito et al1 for classifying six genotypes from A-F with type-specific primers (TSP-PCR) was utilized. In brief, 10 µl of extracted DNA was subjected to 40 cycles of first round PCR using primers 5′-TCA CCA TAT TCT TGG GAA CAA GA-3′ (nt 2823-2845, universal, sense) and 5′CGA ACC ACT GAA CAA ATG GC-3′ (nt 685-704, universal, antisense) amplifying a 1063 bp region of S-gene7.
TSP-PCR was performed in two separate mixes A and B utilizing 1 µl of 1st round PCR product and subjecting to two rounds PCR cycles (20 cycles each) as described by Naito et al7. In mix A, primers specific for genotype A (5′-CTC GCG GAG ATT GAC GAG ATG T-3′ nt 113-134, type A specific, antisense), genotype B (5′-CAG GTT GGT GAG TGA CTG GAG A-3′ nt 324-345, type B specific, antisense), genotype C (5′-GGT CCT AGG AAT CCT GAT GTT G-3′ nt 165-186, type C specific, antisense) and a common universal sense primer (5′-GGC TCA AGT TCA GGA ACA GT-3′ nt 67-86, types A to C specific, sense) were used7.
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