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Journal List > Korean J Gastroenterol > v.57(6) > 1006822

Noh, Cho, Kim, Lee, Park, Joo, Kim, Rew, and Choi: Molecular and Clinical Characterization of Hepatitis A Virus in Gwangju and Jeonnam Province

Abstract

Background/Aims

Dominant genotype of hepatitis A virus (HAV) in Korea had been known to be genotype 1A in 1990s. Recently, the epidemiologic change of HAV genotype was reported with an upsurge of acute hepatitis A in Korea. The aim of this study was to investigate the change of HAV genotypes and clinical characteristics in Gwangju and Jeonnam province.

Methods

From November 2008 to October 2009, a total of 82 patients with acute hepatitis A were enrolled prospectively. HAV genotype was determined using reverse transcriptase polymerase chain reaction and sequencing of the PCR products of VP1/2A region of HAV.

Results

HAV RNA was detected in 82% (67/82). The genotype IIIA (88%, 59 cases) was significantly more frequent than genotype IA (12%, 8 cases) (p≤0.01). The subtypes of genotype IIIA were AJ299467 Norway (49%), HA-JNG04-09 Japan (27%), HS-14-12-00 Spain (22%) and H-122 Sweden (2%). The subtypes of IA were FH1 Japan (50%) and HA J04-3 Japan (50%). The substitutions of amino acid were more frequent in genotype IIIA than IA (p≤0.01). There was no difference in the clinical characteristics between the patients with genotype IIIA and IA.

Conclusions

Genotype IIIA was a dominant genotype of recent HAV infection in Gwangju and Jeonnam province. This study provides valuable epidemiologic information of genetic distributions of HAV in Korea.

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kjg-57-346f1.tif
Fig. 1.
The phylogentic tree generated by clustral V method within MegAlign package in the nucleotide sequences of VP1/2A region of HAV.
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Table 1.
Genotypic Distribution and Characterstics of HAV RNA in Acute Hepatitis A Patients
  Genotype IA Genotype IIIA p-value
Total number of patients (%) 8 (12) 59 (88) 0.000
Subgenotypes (n) FH1 Japan (4) AJ299467  
    Norway (29)  
  HA J04-3 HS-14-12-00  
  Japan (4) Spain (13)  
    HA-JNG04-90  
    Japan (16)  
    H-122  
    Sweden (1)  
Mean identity 99.1±0.4 98.4±1.4 0.136
Number of amino acid change (%) 0 31 (53) 0.005
Table 2.
Comparison of Clinical Findings in Two HAV Genotypes
Parameter Genotype IA (n=8) Genotype IIIA (n=59) p-value
Mean age (years) 27±2.7 30.4±7.0 0.017
Sex (male/female) 6/2 36/23 0.363
Underlying liver disease      
 Hepatitis B virus 1 4 0.482
 Heavy alcohol 1 11 0.250
 Cirrhosis 0 0  
Province (Gwangju/Chonnam) 6/2 44/15 0.674
Laboratory findings      
 Peak ALT (U/L) 4,413±2,775 3,622±2,587 0.466
 Peak total bilirubin (mg/dL) 7.6±4.1 7.8±4.6 0.938
 Prothrombin time (INR) 1.41±0.44 1.42±0.44 0.939
Complication      
 Fulminant hepatitis 0 3 0.514
 Cholestatic hepatitis 0 1 0.711
 Acute kidney injury (Cr≥2.0 mg/dL) 1 4 0.563
Duration of admission (days) 11±13 12±14 0.385
Death 0 1 0.711
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