Thus, it is interesting to discuss the virological advantages disposing this genotype A isolate to become the major player in HBV/HIV-1 coinfection among MSM. One such advantage might be the higher progression rate (16 to 23%) to chronicity of genotype A than of genotype C (28, 30), enhancing its capacity to serve as a source of new infections. As 9 of 26 genotype A-infected patients (35%) http://www.selleckchem.com/products/Y-27632.html were HBcAg IgM positive and 2 had acute hepatitis, it is obvious that genotype A infections are actively ongoing among the MSM population. Though further studies are needed, considering the tMRCA of the prevailing strain A2, the younger age of patients infected with this strain than of those infected with other genotypes, and its high prevalence among MSM, this strain may have acquired higher infectivity and efficient transmission through sexual contact.

Another issue we wanted to clarify in this study was the transmission of antiviral drug resistance. We found no antiretroviral resistance in the 26 sequenced cases. On the other hand, we detected two cases with a mutation combination of rtV173L + rtL180M + rtM204V in HBV reverse transcriptase, demonstrating resistance against lamivudine-emtricitabine. One patient was antiretroviral therapy na?ve; thus, transmission of drug-resistant HBV is strongly suspected. It is peculiar that the isolate harboring the drug-resistant mutations in HBV was a singleton, considering that genetically identical isolates were prevailing, that there were very low mutation rates that suggest few chances of reverting to wild type, and that there were actively ongoing de novo infections.

This finding might be due to resistant viruses being masked by wild-type viruses under untreated conditions, as reported in the case of HIV-1 drug resistance (6). The possibility of minority resistance populations of HBV could be verified by detection with a highly sensitive method. In conclusion, we clarified the molecular epidemiology of HBV/HIV-1 coinfection in Japan. Our data suggest that ongoing HBV infections lie outside prevention programs targeting the MTCT and blood transfusion infection routes, and they suggest the urgent need for new prevention strategies focusing on the high-risk group of the HIV-1-seropositive MSM population. ACKNOWLEDGMENTS This study was supported by a Research Grant for Research on HIV/AIDS from the Ministry of Health, Labor, and Welfare of Japan (no.

H19-AIDS-007, H21-AIDS-005, and H22-AIDS-004). We thank Yasuhito Tanaka, Nagoya City University Graduate School of Medical Sciences, for helpful discussion Batimastat and Claire Baldwin for help in preparing the manuscript. Footnotes Published ahead of print on 19 January 2011.
nonalcoholic fatty liver disease (NAFLD) is an increasingly common cause of liver disease that can progress to nonalcoholic steatohepatitis (NASH) and culminate in end-stage liver disease, featuring liver damage with fibrosis and cirrhosis (1, 10, 36). The pathogenesis of NAFLD/NASH is poorly understood.