Immune-escape mutations and stop-codons in HBsAg develop in a large proportion of patients with chronic HBV infection exposed to anti-HBV drugs in Europe.

  • HIV Clinical and Translational Research
June 01, 2018 By:
  • Colagrossi L
  • Hermans LE
  • Salpini R
  • Di Carlo D
  • Pas SD
  • Alvarez M
  • Ben-Ari Z
  • Boland G
  • Bruzzone B
  • Coppola N
  • Seguin-Devaux C
  • Dyda T
  • Garcia F
  • Kaiser R
  • Kose S
  • Krarup H
  • Lazarevic I
  • Lunar MM
  • Maylin S
  • Micheli V
  • Mor O
  • Paraschiv S
  • Paraskevis D
  • Poljak M
  • Puchhammer-Stockl E
  • Simon F
  • Stanojevic M
  • Stene-Johansen K
  • Tihic N
  • Trimoulet P
  • Verheyen J
  • Vince A
  • Lepej SZ
  • Weis N
  • Yalcinkaya T
  • Boucher CAB
  • Wensing AMJ
  • Perno CF
  • Svicher V
  • Hepvir working group of the European Society for translational antiviral research.

BACKGROUND: HBsAg immune-escape mutations can favor HBV-transmission also in vaccinated individuals, promote immunosuppression-driven HBV-reactivation, and increase fitness of drug-resistant strains. Stop-codons can enhance HBV oncogenic-properties. Furthermore, as a consequence of the overlapping structure of HBV genome, some immune-escape mutations or stop-codons in HBsAg can derive from drug-resistance mutations in RT. This study is aimed at gaining insight in prevalence and characteristics of immune-associated escape mutations, and stop-codons in HBsAg in chronically HBV-infected patients experiencing nucleos(t)ide analogues (NA) in Europe. METHODS: This study analyzed 828 chronically HBV-infected European patients exposed to >/= 1 NA, with detectable HBV-DNA and with an available HBsAg-sequence. The immune-associated escape mutations and the NA-induced immune-escape mutations sI195M, sI196S, and sE164D (resulting from drug-resistance mutation rtM204 V, rtM204I, and rtV173L) were retrieved from literature and examined. Mutations were defined as an aminoacid substitution with respect to a genotype A or D reference sequence. RESULTS: At least one immune-associated escape mutation was detected in 22.1% of patients with rising temporal-trend. By multivariable-analysis, genotype-D correlated with higher selection of >/= 1 immune-associated escape mutation (OR[95%CI]:2.20[1.32-3.67], P = 0.002). In genotype-D, the presence of >/= 1 immune-associated escape mutations was significantly higher in drug-exposed patients with drug-resistant strains than with wild-type virus (29.5% vs 20.3% P = 0.012). Result confirmed by analysing drug-naive patients (29.5% vs 21.2%, P = 0.032). Strong correlation was observed between sP120T and rtM204I/V (P < 0.001), and their co-presence determined an increased HBV-DNA. At least one NA-induced immune-escape mutation occurred in 28.6% of patients, and their selection correlated with genotype-A (OR[95%CI]:2.03[1.32-3.10],P = 0.001). Finally, stop-codons are present in 8.4% of patients also at HBsAg-positions 172 and 182, described to enhance viral oncogenic-properties. CONCLUSIONS: Immune-escape mutations and stop-codons develop in a large fraction of NA-exposed patients from Europe. This may represent a potential threat for horizontal and vertical HBV transmission also to vaccinated persons, and fuel drug-resistance emergence.

2018 Jun. BMC Infect Dis.18(1):251.
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