# Association of human leukocyte antigen B genotypes with COVID-19 severity in Egyptian patients

## TL;DR

This study explores how specific HLA-B genes in Egyptian patients affect the severity of COVID-19, finding that certain alleles are linked to more severe cases.

## Contribution

The study identifies HLA-B alleles associated with severe COVID-19 outcomes in an Egyptian population, offering insights into genetic risk factors.

## Key findings

- HLA-B44 and HLA-B08 alleles were significantly associated with severe COVID-19 cases.
- Lower cycle threshold (Ct) values correlated with more severe disease severity.
- HLA-B genotypes may influence viral load and disease progression in SARS-CoV-2 infections.

## Abstract

Host genetic factors, specifically major histocompatibility complex (MHC) influence the prognosis of COVID-19 infections. It plays a central role in the body’s ability to recognize and respond to pathogens, including viruses like SARS-CoV-2. This study aims to identify the significant human leukocyte antigen B (HLA-B) allele genotypes associated with severe cases among SARS-CoV-2-positive patients attending the PCR unit in The Fever Hospital-Alexandria, Egypt. This cross-sectional study was conducted from November 2022 through April 2023. Two swabs (nasopharyngeal and oropharyngeal) were collected from each patient for RT-PCR to determine the cycle threshold (Ct) value. Subsequently, 2 ml of EDTA blood was drawn from each patient for DNA extraction and HLA-B typing using the INNO-LiPA HLA-B Update Plus kit. Patients were divided according to the severity of their infection: mild (N = 15, mean Ct = 26.27 ± 1.27), moderate (N = 15, mean Ct = 24.20 ± 1.63), and severe (N = 15, mean Ct = 22.27 ± 0.93). Ct values were the lowest amongst the severe group with a mean of 22.27 (p = 0.026). Regarding the severity of SAR-CoV-2 infection, 39 HLA-B genotypes, 6 HLA-B super-types, and 22 HLA-B alleles were identified. HLA-B44 was the most significant allele when comparing the three groups of severity: mild, moderate, and severe (p = 0.044). HLA-B08 and HLA-B44 had a statistical significance of (p = 0.011) and (p = 0.034) respectively when comparing the mild group to hospitalized group (severe + moderate). The Ct value is a clear predictor of SARS-CoV-2 severity. HLA-B44 and HLA-B08 were the most significant alleles associated with severe cases, emphasizing the association of human leukocyte antigen B alleles with disease severity and viral load in determining COVID-19 outcomes. These findings may contribute to the development of personalized medical management and improve strategies for COVID-19 control and prevention.

The online version contains supplementary material available at 10.1038/s41598-026-36948-7.