Kronik Hepatit C Enfeksiyonu Olan Hastaların HCV Genotiplerinin Dağılımı: Üç Yıllık Tek Merkezli Retrospektif Çalışma

Year 2024, Volume: 8 Issue: 2, 133 - 140, 31.08.2024

Melahat Gürbüz , Cengiz Demir , Selahattin Ünlü , Betül Fatmanur Yıldırım , Yeliz Çetinkol

https://doi.org/10.34084/bshr.1527769

Abstract

Amaç: Hepatit C virüsü (HCV), Flaviviridae ailesindeki Hepacivirus cinsine ait tek sarmallı, pozitif anlamlı bir RNA virüsüdür. Bilinen sekiz genotipi ve 93 alt tipi vardır. HCV kan transfüzyonu, cerrahi prosedürler, cinsel temas ve damar içi uyuşturucu kullanımı gibi çeşitli yollarla bulaşabilir ve hem akut hem de kronik hepatite yol açabilir. Genotip (GT) belirleme ve viral yük değerlendirmesi, uygun bir antiviral tedavi rejimi ve süresinin seçilmesi ve tedavi etkinliğinin izlenmesi için esastır. Üç yıllık bir dönem boyunca genotip dağılımını tespit etmeyi amaçladık.
Yöntem: Bu çalışmada, Afyonkarahisar Sağlık Bilimleri Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi'nde 1 Temmuz 2020 ile 30 Haziran 2023 tarihleri arasında kronik HCV enfeksiyonu tanısı alan ve takip edilen hastalar yaş, cinsiyet ve HCV genotip verileri açısından retrospektif olarak değerlendirilmiştir.
Bulgular: Toplam 91 hastanın HCV genotip verileri çalışmaya dahil edilmiştir. Çalışma, hastaların %95,6'sının Türk vatandaşı olduğunu, %4,4'ünün ise yabancı uyruklu olduğunu ortaya koymuştur. 91 hastanın 60'ında (%65,9) genotip 1b, 12'sinde (%13,2) genotip 1a, 10'unda (%11) genotip 3, 6'sında (%6,6) genotip 4, 2'sinde (%2,2) genotip 2 ve bir hastada (%1,1) genotip 3 ve 4 ko-enfeksiyonu olduğu tespit edilmiştir.
Sonuç: Bölgemizde genotip 1b baskın genotip olarak saptandı. HCV genotiplerinin belirlenmesi, kronik HCV enfeksiyonlarının prognoz ve tedavisinin yönlendirilmesinde ve epidemiyolojik değişikliklerin izlenmesinde önemlidir. Bu bilgiler HCV'yi hedef alan sağlık politikalarında ve eliminasyon çalışmalarında büyük değer taşıyacaktır.

Keywords

Hepatit C virüs, HCV genotip, HCV viral yük

Ethical Statement

Çalışma Afyonkarahisar Sağlık Bilimleri Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından belirlenen etik standartlara uygun olarak yürütülmüştür (Karar No. 443-2023/10).

Distribution of HCV Genotypes in Patients with Chronic Hepatitis C Infection: A Three-Year Single-Center Retrospective Study

Abstract

Objective: Hepatitis C virus (HCV) is a single-stranded, positive-sense RNA virus belonging to the genus Hepacivirus in the Flaviviridae family. It has eight known genotypes and 93 subtypes. HCV can be transmitted through various routes, including blood transfusion, surgical procedures, sexual contact, and intravenous drug use, leading to both acute and chronic hepatitis. Genotype (GT) determination and viral load assessment are essential for selecting an appropriate antiviral treatment regimen and duration, and for monitoring treatment efficacy. We aimed to ascertain the genotype distribution over a three-year period.
Methods: In this study, patients diagnosed with chronic HCV infection and followed at Afyonkarahisar Health Sciences University Health Practice and Research Hospital between July 1, 2020, and June 30, 2023, were retrospectively evaluated for their age, gender, and HCV genotype data.
Results: A total of 91 patients’ HCV genotype data were included in the study. The study revealed that 95.6% of the patients were Turkish citizens, while 4.4% were of foreign nationality. Among the 91 patients, 60 (65.9%) were found to have genotype 1b, 12 (13.2%) had genotype 1a, 10 (11%) had genotype 3, 6 (6.6%) had genotype 4, 2 (2.2%) had genotype 2, and one patient (1.1%) had a co-infection of genotypes 3 and 4.
Conclusion: Genotype 1b was dominant in our region. Identifying HCV genotypes is important in guiding the prognosis and treatment of chronic HCV infections and monitoring the epidemiologic changes. This information will be of great value in the health policy that targets HCV and in elimination efforts.

Keywords

Hepatitis C virus, HCV genotype, HCV viral load

Ethical Statement

The study was conducted in accordance with the ethical standards set forth by the Clinical Research Ethics Committee of Afyonkarahisar Health Sciences University (Decision No. 443-2023/10).

Supporting Institution

None

References

• 1. Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743-800.
• 2. Taherkhani R, Farshadpour F. Epidemiology of hepatitis C virus in Iran. World J Gastroenterol. 2015;21(38):10790.
• 3. Smith DB, Bukh J, Kuiken C, et al. Expanded classification of hepatitis C virus into 7 genotypes and 67 subtypes: updated criteria and genotype assignment web resource. Hepatology. 2014; 59: 318–27.
• 4. Borgia SM, Hedskog C, Parhy B, et al. Identification of a novel hepatitis C virus genotype from Punjab, India: expanding classification of hepatitis C virus into 8 genotypes. J Infect Dis. 2018; 218:1722–9.
• 5. Murphy DG, Sablon E, Chamberland J, et al. Hepatitis C virus genotype 7, a new genotype originating from Central Africa. J Clin Microbiol. 2015; 53: 967–72.
• 6. Bukh J, Purcell RH, Miller RH. At least 12 genotypes of hepatitis C virus predicted by sequence analysis of the putative E1 gene of isolates collected worldwide. Proc Natl Acad Sci U S A. 1993; 90: 8234–8.
• 7. Simmonds P, Holmes EC, Cha TA, et al. Classification of hepatitis C virus into six major genotypes and a series of subtypes by phylogenetic analysis of the NS-5 region. J Gen Virol. 1993; 74: 2391–9.
• 8. Larney S, Peacock A, Leung J, et al. Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health. 2017;5:e1208-e1220.
• 9. Maunye TK, Gededzha MP, Blackard JT, Rakgole JN, Selabe SG. Hepatitis C Virus Genotype 5 Variability in Treatment-Naïve Patients in South Africa. Intervirology. 2023;66(1):77-87.
• 10. Gökahmetoğlu S, Atalay MA, Kılınç A. Hepatit C virüs genotiplerinin pirosekanslama yöntemi ile belirlenmesi. Erciyes Tıp Derg 2011; 33: 99-102.
• 11. Cetin AD, Kibar F, Cetiner S, et al. Determination of hepatitis C virus genotype and HCV infection transmission routes in Cukurova University Medical Faculty Hospital. Turk Hij Den Biyol Derg. 2017;74(3):201-10.
• 12. Akgün S, Tarhan G, Sayıner H. S, et al. Adıyaman ilinde hepatit C virüsü genotip dağılımının belirlenmesi. Ortadoğu Tıp Dergisi. 2017; 9(1): 1-5.
• 13. Tiryaki Y, Çetin-Duran A, Özçolpan OO. Distribution of hepatitis C virus genotypes in Aydın Province. Viral Hepat J. 2018;24(3):70-4.
• 14. Öz S, Köroğlu M, Özbek A, et al. Sakarya ilinde hepatit C virüs genotip dağılımı; üç yıllık retrospektif çalışma. OTSBD. 2019;4(4):444-53.
• 15. Sari ND, Karataş A, İncı A, et al. Yerli ve Yabancı Hastalarda Hepatit C Virüs Genotip Dağılımının Değerlendirilmesi. Türkiye Klinikleri. Tip Bilimleri Dergisi. 2020; 40(2):148-53.
• 16. Ağca H, Ener B, Sağlık İ, et al. Hepatit C virüsü genotiplerinin retrospektif incelenmesi. Turk Mikrobiyol Cem Derg. 2021;51(3):303-8.
• 17. Özkaya E, Buruk CK, Aydın F, et al. Distribution of hepatitis C virus genotypes: 18-year experience in an academic center. Viral Hepat J. 2021;27(3):118-23.
• 18. Alacam S, Bakir A, Karatas A. Hepatitis C virus genotypes and viremia in a tertiary hospital in Istanbul, Türkiye. J Infect Dev Ctries. 2022;16: 668-74.
• 19. Bulut, D, Sayar M. S. Van İlindeki Hepatit C Genotip Dağılımı ve Bulaş için Öngörülen Risklerin Değerlendirilmesi. Van Tip Dergisi. 2023;30(4):332-8.
• 20. World Health Organization. Global Hepatitis Report 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
• 21. World Health Organization Global Health Sector Strategy on Viral Hepatitis 2016–2021. Available online: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf;jsessionid=60A93ADD1A191FF6A0FA823314D24C43?sequence=1.
• 22. Gower E, Estes C, Blach S, et al. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol. 2014; 61: S45-57.
• 23. Hauser G, Awad T, Brok J, et al. Peginterferon plus ribavirin versus interferon plus ribavirin for chronic hepatitis C. Cochrane Database Syst Rev. 2014;(2):CD005441.
• 24. Ermis F, Senocak TE. New treatment strategies for hepatitis C infection. World J Hepatol. 2015; 7(17): 2100-2109.
• 25. Jakobsen JC, Nielsen EE, Feinberg J, et al. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev. 2017; 18(9): CD012143.
• 26. Schietroma I, Corano Scheri G, Pinacchio C, et al. HCV and hepatocellular carcinoma: pathogenetic mechanisms and impact of DAA’s. Open Virol J. 2018; 12(Suppl 1, M3): 16-25.
• 27. Guntipalli P, Pakala R, Kumari Gara S, et al. Worldwide prevalence, genotype distribution and management of hepatitis C. Acta Gastroenterol Belg. 2021;84(4): 637-56.
• 28. Spearman CW, Dusheiko GM, Hellard M, et al. Hepatitis C. Lancet. 2019;394:1451-66.
• 29. Di Stefano M, Ismail MH, Leitner T, et al. A novel candidate hepatitis C virus genotype 4 subtype identified by next generation sequencing full-genome characterization in a patient from Saudi Arabia. Frontiers in Microbiology. 2023;14: 1285367.
• 30. Wang B, Krüger L, Machnowska P, et al. Characterization of a hepatitis C virus genotype 1 divergent isolate from an HIV-1 coinfected individual in Germany assigned to a new subtype 1o. Virol J. 2019;16(1):28.
• 31. Oikonomopoulou M, Demetriou V L, Kostrikis L G, et al. Re-analysis of unassigned hepatitis C virus (HCV) strain CYHCV025: evidence of a highly divergent lineage within genotype 1. Mol. Phylogenet. Evol. 2017; 109: 362–6.
• 32. Li C, Cao H, Lu L, et al. Full-length sequences of 11 hepatitis C virus genotype 2 isolates representing five subtypes and six unclassified lineages with unique geographical distributions and genetic variation patterns. J. Gen. Virol. 2012; 93: 1173–84.
• 33. Hundie GB, Raj VS, GebreMichael D, Pas SD, Haagmans BL. Genetic diversity of hepatitis C virus in Ethiopia. PLoS One. 2017;12(6):e0179064.
• 34. Simmonds P, Bukh J, Combet C, et al. Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes. Hepatology.2005; 42: 962–73.
• 35. Ciccozzi M, Equestre M, Costantino A, et al. Hepatitis C virus genotype 4d in southern Italy: reconstruction of its origin and spread by a phylodynamic analysis. J. Med. Virol. 2012; 84: 1613–9.
• 36. Erman Daloğlu A, Parkan ÖM, Erdoğan A, et al. Damar içi madde bağımlılığı olan ve madde bağımlısı olmayan hastalar arasında hepatit C virus (HCV) genotiplerinin dağılımı. Mikrobiyol Bul. 2021;55(1):30-40.
• 37. Çabalak M, Bal T, Demir M, et al. Genotype distribution of hepatitis C virus in Hatay province of Türkiye. Viral Hepat J. 2020;26(2):56-60.
• 38. Kırdar S, Yaşa MH, Aydin N, et al. The distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection. Meandros Medical And Dental Journal. 2015;16(3):108-13.
• 39. Petruzziello A, Marigliano S, Loquercio G, Cacciapuoti C. Hepatitis C virus (HCV) genotypes distribution: an epidemiological up-date in Europe. Infect Agent Cancer. 2016;11:53.
• 40. Altindis M, Dal T, Akyar I, et al. Six-year distribution pattern of hepatitis C virus in Türkiye: A multicentre study. Biotechnol Biotec Eq. 2015;30(2):335-40.
• 41. Kuru C, Hamidi AA. Genotype distribution of hepatitis C virus and demographic features of the patients in the province of Karabük. Viral Hepat J. 2020;26(3):163-6.
• 42. Kuşcu F, Kömür S, İnal AS. Changing epidemiology of chronic hepatitis C in Adana. Viral Hepat J. 2014;20(1):15-8.
• 43. Tezcan S, Ulger M, Aslan G, et al. Determination of hepatitis C virus genotype distribution in Mersin province, Türkiye. Mikrobiyol Bul. 2013;47(2):332-8.
• 44. Bulut ME, Topalca US, Murat A, et al. HCV Genotype Distribution of Patients with Chronic Hepatitis C in Istanbul. Sisli Etfal Hastan Tip Bul. 2021;55(1):86-92.
• 45. Selek MB, Baylan O, Karagöz E, Özyurt M. Changes in hepatitis C virus genotype distribution in chronic hepatitis C infection patients. Indian J Med Microbiol. 2018;36(3):416-21.
• 46. Karabulut N, Alacam S, Yolcu A, Onel M, Agacfidan A. Distribution of hepatitis C virus genotypes in Istanbul, Türkiye. Indian J Med Microbiol. 2018;36(2):192-6.