The level of in vitro detection of viral genomes in mixes with two different hepatitis C virus (HCV) subtypes was investigated by artificially mixing previously measured subtype-specific HCV RNA genomes. The RNAs in these mixtures were reverse transcribed and then PCR amplified by using two sets of primers corresponding to the 5 untranslated region and digested with endonucleases to analyze the restriction fragment length polymorphism patterns. This approach facilitated detection of a wider range of type-specific HCV genomes than originally described, beyond equimolar concentrations of contributing HCV subtypes. Moreover, by using computerized image analysis, this study also demonstrated that the true contribution of each virus type-and consequently of mixed infections-may be underestimated when only visual observation is carried out. These results may be useful for comparing data obtained from this and other currently used methodologies.At present, there are at least six different clades (1 to 6) of hepatitis C virus (HCV), which include 11 types and numerous subtypes (16,17). This hierarchical organization seems to have crucial significance for the epidemiology, diagnosis, clinical course, and pathogenesis of HCV-related disease (21).Molecular genotyping methods are widely used for research purposes. A frequently used noncommercial strategy, restriction fragment length polymorphism (RFLP), employs endonuclease digestion of amplicons from the 5Ј untranslated region (UTR) after conventional reverse transcription-nested PCR (RT-nested PCR) (2,3,10,14).This study was designed to evaluate the ability of RFLP to detect HCV dual infections when two of the three HCV types most prevalent around the world (1, 2, and 3) are combined. Taking into account the known limitation on HCV (sub)type assignment based on 5Ј UTR analysis, in the present work we included HCV isolates from different viral (sub)types determined by analysis of genomic coding regions. Although previous reports have compared RFLP to other methodologies as appropriate techniques for HCV typing (3), the aim of this study was to evaluate whether the coexistence of two different HCV (sub)types influenced the ability to detect one or both (sub)types based upon molar concentrations and, if this were the case, whether one of the (sub)types was preferentially detected.Serum samples. Sera were obtained from 14 patients serologically proven to be chronically infected with HCV, each exhibiting infection with a single virus type, 1, 2, 3, or 4, as documented by cDNA sequencing of viral genomic coding regions (NS5B or core) followed by phylogenetic analysis. To minimize the risk of potential mixed infections in the samples, the selection criteria for these 14 patients were their lack of parenteral risk of infection and the absence of any known exposure to a potential infectious source as indicated by their answers to an exhaustive questionnaire. Therefore, such strains were ascribed to sporadic (community-acquired) cases of HCV infections. The samples from these patie...