**3. Results**

#### *3.1. Demographic Characteristics of Patients*

Eighty-two HBV positive patients (48 males, 34 females), were screened for the di fferent genotypes A, B, C, D, E and mixed genotype infections A/D, B/D, D/E. The patients in the study were either Bahraini nationals or from other nationalities. The frequency of Bahraini was found to be 53.7% and that of Non-Bahraini was 46.3%. The highest prevalence of HBV infection was shown for the age group 21–30. The lowest prevalence was for the group <21. There was no significance di fference between genotype and nationality, gender and age-group (*p* > 0.05), as shown in Table 1.


**Table 1.** Sociodemographic factors associated with the prevalence of hepatitis B virus infections examined patients (N = 82).

1 Data presented as %(No.).

#### *3.2. Distribution of HBV Genotypes in the Study Population*

Figure 1 illustrates the frequency of HBV genotypes A, A/D, B, B/D, C, D, D/E, and E. The prevalence of genotype A was found to be 10%, genotype A/B was 7%, genotype B was 4%, genotype B/D was 2%, genotype C was 5%, genotype D/E was 4%, genotype E was 1%, and undetermined genotypes was 6%. Among the referred genotypes, genotype D showed the highest occurrence (61%), which indicated that genotype D is the most prevalent HBV genotype in the Kingdom of Bahrain.

**Figure 1.** Prevalence of HBV genotypes among 82 patients under study in the Kingdom of Bahrain.

#### *3.3. Genotype and Sociodemographic Data*

Table 2 states the distribution of genotypes with respect to gender, nationality, and age groups. The prevalence of HBV infection for each genotype differs for gender, but there is no significance difference in terms of genotype prevalence and genders (*p* = 0.447; *p* > 0.05). Overall, the genotype A (62.5%), A/D (66.7%), B (66.7%), C (100%), and D/E (100%) are more related to males, whereas genotype E (100%) and Undetermined genotype (60%) are more related to females. Genotype A/D (66.7%), D (64.0%), and Undetermined genotypes (80%) are more related to Bahraini nationality; Genotype A (87.5%), B (6.7%), C (75%), D/E (100%), and E (100%) are more related to other nationalities. Genotype B/D (50%) is equally distributed among and Bahrainis and non-Bahrainis. Individuals of different age groups were enrolled in the study, there was no significance differences in terms of genotype prevalence and age (*p* = 0.409; *p* > 0.05).

#### *3.4. HBV Genotype Relationship with Mode of Transmission and Liver Cirrhosis Complications*

Table 3 shows the prevalence of HBV genotypes in relationship to the mode of transmission and liver cirrhosis complications. There are no significant differences (*p* > 0.05) in genotype frequency in relation to the mode of transmission (*p* = 0.086) and liver cirrhosis complications (*p* = 0.857). Genotype A (37.5%), A/D (66.7%), D (66%), D/E (100%), and undetermined genotype (80%) are more related to the unknown factor of infection transmission. Genotype B (66.7%) and C (75.5%) are more related to Blood transfusion while genotype E (100%) is more related to vertical transmission from mother to child. Genotype D (2%) is more related to hemodialysis, while genotype A (12.5%) is more related to tattoo/body piercing. In general, there was low or no relationship between the prevalence of HBV genotypes and liver cirrhosis complications, for example, genotype A (50%), genotype A/D (66.7%), genotype B (100%), genotype C (100%), genotype D (78%), genotype D/E (100%), and undetermined (80%), except for mixed genotypes B/D, 50% of the patients were associated with ascites.


*Medicina* **2019**, *55*, 622

B/D 50.00% 0.00% 50.00% 0.00% 0.00% 50.00% 50.00% 0.00% 0.00% 0.00% C 25.00% 75.00% 0.00% 0.00% 0.00% 100.00% 0.00% 0.00% 0.00% 0.00% D 66.00% 16.00% 6.00% 8.00% 2.00% 78.00% 16.00% 2.00% 2.00% 2.00% D/E 100.00% 0.00% 0.00% 0.00% 0.00% 100.00% 0.00% 0.00% 0.00% 0.00% E 0.00% 0.00% 0.00% 100.00% 0.00% 100.00% 0.00% 0.00% 0.00% 0.00% Undetermined 80.00% 20.00% 0.00% 0.00% 0.00% 80.00% 20.00% 0.00% 0.00% 0.00%

#### *3.5. HBV Genotype and Liver Function Test*

For the determination of HBV clinical course, investigating the hepatic biomarkers plays an important role. As increase or decrease in their levels can indicate hepatic disfunction. Bilirubin, Direct Bilirubin (Dbilirubin), Alanine transaminase (ALT), Aspartate aminotransferase (AST), and Gamma-Glutamyl Transferase (GGT) were measured and associated with the different genotypes. Table 4 summaries the mean and SD values in relation to the different genotypes. The maximum and minimum range for these liver function enzymes were stated as: Bilirubin (max. 17, min. 0 umol/L), Dbilirubin (max. 3.4, min. 0 umol/L), AST (max. 37, min. 0 lU/L), ALT (max. 41, min. 0 lU/L), and GGT (max. 49, min. 11 lU/L). Table 4 shows that for Bilirubin value A/D mixed genotype was higher than the max range; for D bilirubin, no genotypes were above or below the normal range, while for AST, ALT, and GGT, the genotypes A, A/D, B, and B/D were all above the normal range.

**Table 4.** Mean and Standard Deviation of Liver Function Tests, Univariate Analysis with HBV Genotype.


\* Refers to the measured levels of the liver functions enzymes above their min. and max. ranges.
