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Super-infection with multiple HBV genotypes
Jan 24, 2008

Dear Doctor McGovern,

I was dignosed with chronic HepB. My doctor told me there was no active inflammtion in the liver, HBeAg cleared, and viral load below 10,000 copies. That is, I appear to be an "inactive carrier". I also learn from him that HepB virus come in different genotypes. Some genotypes are more aggressive than the others.

Since I am a HBsAg positive, I think I am vulnerable to any further exposure to HBV (correct me if I am wrong). Vaccines cannot induce immunity on me.

What happens if I get exposed to a genotype other than the one I currently carry? Will the event alter the course of my disease? I know that HIV patients can be superinfected with additional clades, and so can HCV patients. In both cases the superinfection worsens the situation. Does the same go for HBV?

Thanks.

Response from Dr. McGovern

This is a very interesting question. Yes you are absolutely right that "superinfection" - eg, infection with another virus, can occur with different clades of HIV in an HIV-infected patient. In Hepatitis C, we can see multiple genotypes in the same individual. This was commonly seen in the distant past in patients with multiple blood transfusions.

In hepatitis B, we always talk about "superinfection" in the context of being infected with another hepatitis virus like hepatitis A, C, or delta. I am not aware of data demonstrating human infection with multiple HBV genotypes. In matter of fact, in an animal model, superinfection was shown NOT to occur in liver cells that were already infected with HBV.



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