Abstract
Hepatitis B virus (HBV) infection remains a major public health problem particularly in Asia and Pacific that belongs to hepatitis B endemic regions. With high genetic diversity of the entire genome, this DNA virus has been classified into eight genotypes, genotype A to H, and recently two new genotypes, I
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and J, has been found in Asia. Interestingly, distribution of HBV genetic diversity is geographically specific worldwide. Further, distribution of HBV genetic diversity in Indonesia is associated and follows the ethnic background and geography of host. The distribution of HBV genotype B and C in Indonesia has been suggested co-migrated with the peopling of the Indonesian archipelago in the past. Internal viral genomic evolution including inter-strain recombination and pressure by host immune response has been suggested to give strong contribution in the genetic diversity of HBV. Thus, HBV genetic diversity is partly due to virus-host interactions and partly due to parallel evolution in geographically distinct areas. Some of these variations have significant impact to public health and clinical settings. Mutations within Hepatitis B surface Antigen (HBsAg) particularly in the ‘a’ determinant may cause HBsAg undetectable by commercially available assays. These mutations give significant impact to antigenic index and tertiary structure prediction that might cause failure of HBsAg detection. The occurrence of such mutations is partly the background of occult hepatitis B, and could mislead the diagnosis and disease management. It may have significant implication to public health, particularly in the detection failure of HBV in blood donors. With this alarming data, national policy for screening blood donors on HBsAg detection should be reviewed. Further, this situation reiterates medical professionals to be more careful in giving blood and or blood products. Therefore, HBV genetic diversity is of medical and public health concern. In addition, HBV genetic diversity information can be used in tracing human migration particularly in Asia-Pacific. It can be concluded that the knowledge in HBV genetic diversity is important for understanding the pathogenesis of HBV infection and the related host immune system, providing important contribution to hepatitis B molecular epidemiology, with implication in reducing subsequent morbidity and mortality. This HBV diversity data can be used as important information that is ethnically specific for the development of diagnostic tools and vaccines. In parallel, the knowledge of HBV genomic variety can be integrated and linked to non-clinical purposes in linguistic, human genetic and archeological perspectives in the efforts to maximize human health
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