Journal of Medical Virology 84:1548–1552 (2012) Unexpected Distribution of Hepatitis B Genotypes in Patients With Kidney Disease: Comparison With Immunocompetent Subjects Luciana O. Souza, 1,2 Renata M. Perez, 3 Roberto J. Carvalho-Filho, 1 Carla A.L. Matos, 1 Renata S. Moutinho, 1 Ivonete S. Silva, 1 Jose O. Medina-Pestana, 4 Antonio E.B. Silva, 1 and Maria L. Ferraz 1 * 1 Division of Gastroenterology, Federal University of Sao Paulo, Sao Paulo, Brazil 2 Virology Service, Adolfo Lutz Institute, Sao Paulo, Brazil 3 Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil 4 Division of Nephrology, Federal University of Sao Paulo, Sao Paulo, Brazil Hepatitis B virus (HBV) infection has a high prevalence among hemodialysis and renal transplant patients. Data regarding genotype distribution in these populations are scarce and are still under investigation. The aim of this study was to evaluate the distribution of HBV genotypes in end-stage renal disease (ESRD)- patients and renal transplant patients and to compare with the distribution observed in im- munocompetent patients from the same geo- graphic region. From a population of 213 patients evaluated initially, 120 patients with detectable HBV-DNA were included in the study and submitted to genotype determination by amplification of S gene by nested PCR followed by sequencing method. Among 41 hemodialy- sis patients the most frequent genotype was D (83%), followed by genotype A (10%), C (5%), and F (2%). Genotype D was also the most prevalent (73%) among 33 renal transplant patients, followed by genotype A (18%), F (6%), and B (3%). This distribution was similar in these two groups of patients and for the com- parative analysis they were considered in the kidney disease group. Compared to immuno- competents, patients with kidney disease (ESRD and renal transplant patients) showed a distinct distribution, with a higher prevalence of genotype D (78% vs. 17%, P < 0.001) where- as genotype A was the most prevalent among immunocompetent patients (70% vs. 14%, P < 0.001). In conclusion, the higher frequency of genotype A in immunocompetent patients and of genotype D in patients with renal dis- ease suggest a higher capacity of environmen- tal transmission or a better adaptability of this genotype in patients with a different pattern of immunologic response. J. Med. Virol. 84: 1548–1552, 2012. ß 2012 Wiley Periodicals, Inc. KEY WORDS: hepatitis B; genotype; hemo- dialysis; renal disease; kidney transplantation INTRODUCTION The prevalence of hepatitis B in dialysis centers is high and proportional to the prevalence of this infec- tion in the general population, with the main route of transmission being environmental exposure to infected blood [Tang and Lai, 2005]. Chronic hepatitis B virus (HBV) infection in end-stage renal disease (ESRD) patients on hemodialysis has a negative im- pact on the prognosis of these subjects, resulting in hepatic complications [Wong et al., 2005] and conse- quent high morbidity and mortality. In the case of renal transplant recipients, HBV is acquired generally during hemodialysis or, exception- ally, at the time of transplantation [Dickson et al., 1997]. In these patients, the effect of immunosuppres- sion may result in the reactivation of infection and exacerbation of viral replication [Chan and Moorhead, 1981], thus aggravating the clinical course of the dis- ease [Fabrizi et al., 2002]. Knowledge about HBV genotyping in different pop- ulations is clinically relevant, since it might have an impact on clinical course and response to the treat- ment. The worldwide distribution of HBV genotypes varies widely and their prevalence reflects not only *Correspondence to: Maria L. Ferraz, Rua Machado Bitten- court 413, apto 81, 04044-001 Sa ˜o Paulo - SP Brazil. E-mail: marialucia.ferraz@fleury.com.br Accepted 29 May 2012 DOI 10.1002/jmv.23357 Published online in Wiley Online Library (wileyonlinelibrary.com). ß 2012 WILEY PERIODICALS, INC.