Younger trend of cirrhosis incidence in genotype 3 HCV infected patients in Eastern China

Abstract

The diversity of HCV genotypes is ever-evolving and requires continuous surveillance. The aim of this study was to investigate the dynamics of HCV genotypes, and their associated demographic and clinical patterns in China. By searching computerized hospital information system, a total of 1155 HCV-positive patients eligible for analysis were retrospectively identified from 12 380 consecutive in-patients in the Department of Infectious Diseases, Ruijin Hospital in China between 2009 and 2014. The percentages of HCV genotype 1, 2, 3, or 6 were 61.3%, 12.8%, 18.5%, or 7.4%, respectively. The number of patients hospitalized for HCV infection increased gradually over the study period, particularly those infected by genotype 3 HCV. Patients of genotype 1, 2, 3, or 6 were significantly different. Genotype 1 or two patients were much older, with higher proportion of blood transfusion history. In contrast, genotype 3 or six patients were younger, predominantly male, with more exposure to intravenous drug use. The cirrhosis incidence was higher in genotype 1 or two patients, followed by genotype 3 and six patients. Strikingly, genotype 3 cirrhotic patients were younger, and their estimated infection durations were also shorter, suggestive of a faster disease progression in genotype 3 patients. Multivariate analysis demonstrated that presence of HBcAb was an independent predictor of cirrhosis (OR 2.19, 95%CI 1.27-3.42; P = 0.004). The leading increase and the younger trend of cirrhosis incidence in genotype 3 patients argue for a higher priority to manage the infection in this highly at-risk population.

Subtype-Specific Prevalence of Hepatitis C Virus NS5A Resistance Associated Substitutions in Mainland China

“…In China, GT1b is estimated to account for more than 50% of total HCV infections (Chen Y. et al, 2017). GT3 is the next most prevalent globally and has increased dramatically in China (Messina et al, 2015; Lu et al, 2017). Meanwhile, HCV exists in host as quasispecies, which is defined as genetically distinct, but closely related viral populations (Martell et al, 1992).…”

Study of the Effect of Different Hepatitis C Virus Genotypes on Splenomegaly

“…The stage of fibrosis, as measured by APRI (aspartate aminotransferase-to-platelet ratio index), was higher in younger patients with GT 3 (below 50 years old). This study explained disease progression by estimating that the disease duration for developing cirrhosis was 16.6 years for GT 3 and 21.0 years for non-GT 3 (P=0.04) [ 7 ]. The earlier the cirrhosis develops, the more likely splenomegaly will develop in the course of the HCV genotype.…”

“…Secondly, GT 3a may be more resistant to treatment by DAAs (direct-acting antivirals) and hence it may have more chances of disease progression and splenomegaly. GT 3 viruses also have a low sensitivity against DAAs and show more association with steatosis [ 7 ]. In accordance with our statistics, our study calls for earlier screening and diagnosis of hepatitis C infection and the detection of its genotypes.…”

“…The most prevalent HCV genotype in Pakistan is GT 3, especially its subtype 3a, which makes up 61.3% of all HCV patients in Pakistan [ 4 ]. GT 3 is also the most virulent subtype, with an accelerated disease progression to cirrhosis and a worse response to antiviral drugs [ 7 ].…”

“…Hence, the HCV genotype and its virulence may have a direct implication on the development of splenomegaly later in the disease and may explain the overall variable rates of splenic enlargement. Studies have shown that GT 3 is associated with a faster progression to cirrhosis [ 7 ], and, therefore, we expect to have an increased incidence of splenomegaly in GT 3 patients. This would warrant increased surveillance and aggressive treatment of splenomegaly in such patients to avoid possibly life-threatening complications such as infections, anemia, bleeding, stiffness, and spleen rupture.…”