Analysis of mutational patterns of the pre-C/C region of with hepatitis B virus in patients with HBV-associated acute-on-chronic liver failure

ObjectiveTo analyze the mutational patterns of the pre-C/C region of hepatitis B virus (HBV) in patients with HBV-associated acute-on-chronic liver failure (HBV-ACLF). MethodsA total of 166 patients with chronic HBV infection were enrolled in the study, including 49 cases of ACLF, 45 cases of chronic hepatitis B (CHB), 45 cases of liver cirrhosis (LC), and 27 cases of hepatocellular carcinoma (HCC). The pre-C/C region of HBV was amplified by polymerase chain reaction and then analyzed to determine the number of mutations and mutational patterns. ResultsMulti-site mutations occurred significantly more frequently in ACLF patients than in other patients. Among the four groups of patients, those with ACLF had the highest rates of 5-site and 7-site mutations ［20.4% (10/49) and 12.2% (6/49)］; they had a similar rate of 6-site mutations as HCC patients ［14.3% (7/49) vs. 14.8% (4/27)］, but this was significantly higher than patients with CHB and LC. The mutational pattern analysis showed that multi-site mutations that included those at nt 1846 and nt 1913 were more likely to occur in patients with ACLF than in the other groups. ConclusionCompared with other patient groups with chronic HBV infection, ACLF patients had a higher frequency of multi-site mutations in the pre-C/C region of HBV, with the highest rates of multi-site mutations containing mutations at nt 1846 and nt 1913.