Molecular identification of hepatitis B virus genotypes/subgenotypes:Revised classification hurdles and updated resolutions

The clinical course of infections with the hepatitis B virus(HBV)substantially varies between individuals,as a consequence of a complex interplay between viral,host,environmental and other factors.Due to the high genetic variability of HBV,the virus can be categorized into different HBV genotypes and subgenotypes,which considerably differ with respect to geographical distribution,transmission routes,disease progression,responses to antiviral therapy or vaccination,and clinical outcome measures such as cirrhosis or hepatocellular carcinoma.However,HBV(sub)genotyping has caused some controversies in the past due to misclassifications and incorrect interpretations of different genotyping methods.Thus,an accurate,holistic and dynamic classification system is essential.In this review article,we aimed at highlighting potential pitfalls in genetic and phylogenetic analyses of HBV and suggest novel terms for HBV classification.Analyzing fulllength genome sequences when classifying genotypes and subgenotypes is the foremost prerequisite of this classification system.Careful attention must be paid to all aspects of phylogenetic analysis,such as bootstrapping values and meeting the necessary thresholds for(sub)genotyping.Quasi-subgenotype refers to subgenotypes that were incorrectly suggested to be novel.As many of these strains were misclassified due to genetic differences resulting from recombination,we propose the term"recombino-subgenotype".Moreover,immigration is an important confounding facet of global HBV distribution and substantially changes the geographic pattern of HBV(sub)genotypes.We therefore suggest the term"immigro-subgenotype"to distinguish exotic(sub)genotypes from native ones.We are strongly convinced that applying these two proposed terms in HBV classification will help harmonize this rapidly progressing field and allow for improved prophylaxis,diagnosis and treatment.

An extremely rare case of delusional parasitosis in a chronic hepatitis C patient during pegylated interferon alpha-2b and ribavirin treatment

During treatment of chronic hepatitis C patients with interferon and ribavirin, a lot of side effects are described. Twenty-three percent to 44% of patients develop depression. A minority of patients evolve to psychosis. To the best of our knowledge, no cases of psychogenic parasitosis occurring during interferon therapy have been described in the literature. We present a 49-year-old woman who developed a delusional parasitosis during treatment with pegylated interferon alpha-2b weekly and ribavirin. She complained of seeing parasites and the larvae of fleas in her stools. This could not be confirmed by any technical examination. All the complaints disappeared after stopping pegylated interferon alpha-2b and reappeared after restarting it. She had a complete sustained viral response.

Early prediction of major depression in chronic hepatitis C patients during peg-interferon α-2b treatment by assessment of vegetative-depressive symptoms after four weeks

AIM: To study the predictive value of the vegetative- depressive symptoms of the Zung Depression Rating Scale for the occurrence of depression during treatment with peg-interferon α-2b of chronic hepatitis C (CHC) patients. METHODS: The predictive value of vegetative- depressive symptoms at 4 wk of treatment for the occurrence of a subsequent diagnosis of major depressive disorder (MDD) was studied in CHC patients infected after substance use in a prospective, multi- center treatment trial in Belgium. The presence of vegetative-depressive symptoms was assessed using the Zung Scale before and 4 wk after the start of antiviral treatment. RESULTS: Out of 49 eligible patients, 19 (39%) developed MDD. The area under the ROC curve of the vegetative Zung subscale was 0.73, P = 0.004. The sensitivity at a cut-point of > 15/35 was 95% (95% CI: 74-100). The positive predictive value equalled 44% (95% CI: 29-60). CONCLUSION: In this group of Belgian CHC patients infected after substance use, antiviral treatment caused a considerable risk of depression. Seven vegetativedepressive symptoms of the Zung scale at wk 4 of treatment predicted 95% of all emerging depressions, at a price of 56% false positive test results.