Molecular epidemiology of hepatitis C virus (HCV) in Greece: temporal trends in HCV genotype‐specific incidence and molecular characterization of genotype 4 isolates

Abstract

This study aimed to estimate the overall HCV genotype distribution and to reconstruct the HCV genotypespecific incidence in Greece during the recent decades. It also focused at the identification of genotype 4 subtype variability in Greek isolates. A total of 1686 chronically infected HCV patients with detectable serum HCV RNA by RT-PCR, belonging to different risk groups were studied. Amplified products from the 5¢-noncoding region were typed using a commercially available assay based on the reverse hybridization principle. The HCV genotype-specific incidence was estimated using a previously described back calculation method. HCV genotype 1 was the most prevalent (46.9%) followed by genotype 3 (28.1%), 4 (13.2%), 2 (6.9%) and 5 (0.4%). A high prevalence of genotype 1 (66.3%) in haemophilia patients was recorded whereas HCV genotype 3 was found mainly among patients infected by I.V. drug use (58.2%). Data on the temporal patterns of HCV genotype-specific incidence in Greece revealed a moderate increase (1.3-1.6 times) for genotypes 1 and 4, and a decrease (1.5 times) for genotype 2 from 1970 to 1990, whereas there was a sharp (13-fold) increase for genotype 3. The molecular characterization of 41 genotype 4 HCV isolates belonging to various risk groups revealed that, subtype 4a was the most frequently detected (78%). Phylogenetic comparison of the Greek 4a isolates with all HCV-4a isolates reported worldwide so far revealed a topology which does not discriminate Greek isolates from the others. HCV-4 does not represent a recent introduction in Greece.

Genotype 4 Hepatitis C Virus Responds Worse than Genotype 1 to 48-Week Combination Treatment with Pegylated Interferon Alpha Plus Ribavirin: a Greek Multi-Centered Study

“…In Greece, prevalence of genotype 4 is amongst the highest reported within Europe, estimated around 15% [18][19][20][21][22]. Similarly, a percentage of 14.7% was confirmed in our study cohort of consecutive HCV patients.…”

“…In Greece, genotype 4 accounts for about 15% of all HCV infections [18][19][20][21][22] and is generally considered as "difficult to treat" in everyday clinical practice.…”

Complete genomic sequences for hepatitis C virus subtypes 4b, 4c, 4d, 4g, 4k, 4l, 4m, 4n, 4o, 4p, 4q, 4r and 4t

“…Since the 1930s some strains have become prevalent in North Africa as a result of large-scale vaccination campaigns (Angelico et al, 1997;Tanaka et al, 2004). Recently, a variety of these strains have been found in Southern European countries on the Mediterranean Sea (Ansaldi et al, 2005;Fernández-Arcás et al, 2006;Franco et al, 2007;Katsoulidou et al, 2006;Nicot et al, 2005;Payan et al, 2005). Although infection due to genotype 4 is not common in the USA and Canada, most of the reported cases were clustered among IDUs or immigrants from countries where HCV-4 is known to be most prevalent or among individuals who acquired the infection in these countries (Lyra et al, 2004;Timm et al, 2007;Zein et al, 1996).…”

HCV non-1b genotypes in injecting drug users from Romania

“…Subtype 1a is predominant in Spain [8] and Portugal [9], countries with an important number of Romanian migrants, as well as in the Netherlands [10], while subtype 3a dominates in France [11], Belgium [12], and Cyprus [13], the latter a country that employs a high number of Romanian workers. Genotype 4 is continuously increasing in prevalence in southern Europe, especially in Greece [14], as well as in Italy [15], Portugal [9], and Spain [8].…”