Seroprevalence and Genotypic Characterization of HBV among Low Risk Voluntary Blood Donors in Nairobi, Kenya

Abstract

Background: Hepatitis B virus (HBV) causes signifcant morbidity and mortality globally primarily due to its ability to cause hepatitis, liver cirrhosis and hepatocellular carcinoma. The Kenya National Blood Transfusion Services screens for Hepatitis B antibodies using the chemiluminescent microparticle immunoassay method. This test does not inform on the genotypic characteristics of the virus or the actual presence of the virus in blood. This study therefore sought to determine the serologic and genotypic profles of HBV circulating among the voluntary blood donors in Nairobi. Methods: Blood samples were collected in plain and EDTA vacutainers and tested for the Hepatitis B surface antigen (HBsAg). HBV DNA was then extracted from plasma, its overlapping P/S gene amplifed and sequenced. The resulting sequences were used to analyze for the circulating genotypes and mutations within the P and S genes. Bivariate statistical analysis was used to determine the association between demographic factors and HBV infection. Results: A seroprevalence of 2.3% (n=7) was reported. The age group 19–28 years was signifcantly associated with HBV infection. Nine samples were positive for HBV DNA; these included 2 HBsAg positive samples and 7 HBsAg negative samples. Genotype A, sub genotype A1 was found to be exclusively prevalent while a number of mutations were reported in the “a” determinant segment of the major hydrophilic region of the S gene associated with antibody escape. RT mutations including mutation rt181T in the P gene conferring resistance against Lamivudine and other ʟ-nucleoside drugs were detected. Conclusion: There is a high prevalence of occult HBV infections among these blood donors and therefore the testing platform currently in use requires revision. Keywords: Occult HBV infection, Hepatitis, Liver cirrhosis, Hepatocellular carcinoma, Mutations, Escape mutations, Undetectable