High levels of HBsAg with low plasmatic HBV-DNA in young African refugees with HBV genotype infection: an indication for early treatment

body: BACKGROUND: Africa represent the second area of the word for prevalence of Hepatitis B Virus (HBV) infection and 2% of deaths are caused by Hepatocellular Carcinoma (HCC) or Cirrhosis. Few data about distribution, clinical evolution and treatment response of Africans genotypes are available. Goal of this study was to retrospectively observe a population of young subjects coming from West Africa's country . METHODS: A population of 262 patients coming from 5 migrant's shelters in Rome was screened for HBV, HCV, HIV, syphilis and tuberculosis in the Clinical of Infectious Disease of Tor Vergata University in one year (Nov 2013-Nov 2014). RESULTS: One hundred and forty-seven (55,7%) out of 262 males patients screened (, median age (IQR) 23 (21-26) years), presented HBV infection, , 5 (1,9%) resulted anti-HCV positive and 3(1,14%) anti-HIV and VDRL positive. One hundred and six (72,1%) out of 147 HBV-infected patients were HbsAg-negative (42 anti-Hbc and anti-Hbs positive, 64 only anti-Hbs positive), whereas 41 (27,8%) were HbsAg positive. All HbsAg-positive subjects were drug-naive, the median (IQR) HBV-DNA was 4.709 (332-5041) IU/mL and quantitative HbsAg was 12.184 (1635-13819) IU/mL. No coinfection with HDV neither elevation of transaminases was found. One case had HCC. The analysis of viral genotype (available for 32 out of 41 (78%) patients) evidenced high prevalence of genotype E (84,3% (27/32) patients), who presented T140S innate mutation in HbsAg. This mutation is associated with immunological escape. Five patients had a genotype A1, carrier two mutation of immunological escape too: T131N and Y100C. CONCLUSIONS: Our results demonstrated a high prevalence of chronic HBV infection associated to E genotype in a population of young refugee coming from areas of high prevalence of HBV infection and HCC. The virus strains isolated from the majority of the subjects showed T140S mutation associated with immunological escape wich can be related, with high levels of HbsAg, to the persistence of the infection and possible evolution in HCC suggestive for early initiation of therapy.