![]() The molecular epidemiology suggests circulation of multiple subtypes and provides evidence for ongoing recent transmissions. Importantly, we found multiple residues with strong support for HLA class I-associated selection pressure consistent with a functional CD8 + T cell response directed against HDV.Ĭonclusion: HDV isolates from Mongolia are highly diverse. In turn, from phylogeny there is strong evidence for recent local transmission events. Phylogenetic analysis revealed that all Mongolian HDV isolates belong to genotype 1, however, they separate into several different clusters without clear regional association. The complete large HDAg was successfully sequenced from 131 samples. Results: Of 431 HBsAg positive patients, 281 were anti-HDV positive (65%), and HDV-RNA could be detected in 207 of 281 (74%) of patients. ![]() Residues under selection pressure in the presence of individual HLA class I types were identified with the recently published analysis tool HAMdetector. For all individuals the HLA class I locus was genotyped. Patients and methods: From the HepMongolia cohort from rural areas in Mongolia, 451 HBsAg-positive individuals were selected and anti-HDV, HDV-RNA and the sequence of the large HDAg was determined. The aim of the study was to characterize the sequence diversity of HDV in rural areas from Mongolia and to determine the extent of HLA class I-associated selection pressure. Objectives: Although it is well established that Mongolia is the country with the highest prevalence of HDV infections, the information on the molecular epidemiology and factors contributing to HDV sequence diversity are largely unclear. Worldwide 12 million people are chronically infected with HDV being at high risk for progression to cirrhosis and development of liver cancer. Currently, hepatitis D is the most aggressive form of viral hepatitis and treatment options are limited. Introduction: The Hepatitis Delta Virus (HDV) is a defective, single-stranded RNA virusoid encoding for a single protein, the Hepatitis Delta Antigen (HDAg), which requires the hepatitis B virus (HBV) envelope protein (HBsAg) for its transmission. 5Institute of Biomedical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.4Institute for Transplant Diagnostics and Cell Therapeutics, University Hospital Dusseldorf, Dusseldorf, Germany.3Bioinformatics and Computational Biophysics, Faculty of Biology, University of Duisburg-Essen, Essen, Germany.2Institute of Virology, University Hospital Düsseldorf, Düsseldorf, Germany.1Department of Microbiology and Infection Prevention and Control, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.Fischer 4, Battogtokh Chimeddorj 1,5, Andreas Walker 2 * ‡ and Jörg Timm 2 * ‡ Battur Magvan 1 †, Anne Alina Kloeble 2 †, Johannes Ptok 2, Daniel Hoffmann 3, Daniel Habermann 3, Anuujin Gantumur 1, Martha Paluschinski 2, Gerelmaa Enebish 1, Vera Balz 4, Johannes C.
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