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Unexpected high prevalence of hepatitis C virus genotype 4 in Southern Spain
A Sánchez-Quijano1, M A Abad, R Torronteras
1Viral Hepatitis and AIDS Study Group, Department of Internal Medicine, Virgen del Rocío University Hospital, Seville, Spain. aquijano@.cica.es
Insights
A significant number of Hepatitis C virus (HCV) infections, particularly genotype 4, were missed by standard PCR and LIPA methods in Southern Spain. Nested PCR identified these cases, revealing lower viral loads in genotype 4 infections.
Area of Science:
- Hepatology
- Virology
- Molecular Diagnostics
Background:
- A high prevalence of undeterminable Hepatitis C virus (HCV) genotypes was observed in a specific region.
- Standard diagnostic methods (single PCR and LIPA) were insufficient for accurate HCV genotyping in a notable proportion of patients.
Purpose of the Study:
- To investigate the epidemiological, clinical, and molecular characteristics of HCV-infected individuals with unresolvable genotypes.
- To identify the specific HCV genotypes missed by conventional methods.
Main Methods:
- A cross-sectional study included 80 anti-HCV positive patients with chronic liver disease.
- HCV genotyping was performed using single PCR and LIPA, with nested PCR applied to indeterminate samples.
- HCV viral load was quantified for all participants.
Main Results:
- HCV genotyping failed in 28.75% of patients using standard methods.
- Nested PCR identified HCV genotype 4 in 47.82% of these previously ungenotyped cases.
- HCV genotype 4 was associated with lower viral loads compared to genotypes 1, 2, and 3.
Conclusions:
- Southern Spain exhibits a high rate of HCV genotype 4 infections that are difficult to detect with single PCR and LIPA.
- The use of nested PCR is crucial for accurate HCV genotyping, preventing misclassification of patients as non-viremic.
Background/Aims:
A unusually high rate of HCV-infected individuals in whom the HCV genotype cannot be ascertained by means of single PCR and LIPA procedures has recently been reported in our area. The aim of the present study was to investigate the epidemiological, clinical and molecular characteristics of these patients.
Methods:
Cross-sectional study. Eighty anti-HCV-positive patients with chronic liver disease, 45 (56.25%) of them intravenous drug users, were included. HCV genotyping was carried out in all patients using commercial single PCR and LIPA procedures. Samples where no HCV RNA amplification and/or indeterminate HCV genotype were found were also tested by means of a nested PCR. HCV viral load was measured in all patients.
Results:
HCV genotyping was not achieved in 23 (28.75%) individuals. No amplification of HCV RNA was found in 19 of them, and in four other cases the LIPA procedure did not allow identification of a distinct HCV genotype. After the use of nested PCR+LIPA, it was found that the HCV genotype 4 was found in 11 of those 23 individuals (47.82%). Ten of these 11 HCV genotype 4-harboring individuals were intravenous drug users. The HCV viral load was lower in HCV genotype 4-harboring individuals than in those whom the genotypes 1, 2 or 3 were found (p<0.001).
Conclusions:
A high rate of HCV genotype 4-harboring cases has been found among HCV-infected individuals in Southern Spain. Had only single PCR been used, these individuals could have been wrongly regarded as non-viremic.