Phylogenetic analysis of HCV‐4d in Turkey: the curious case of Kayseri Province

Abstract

In Turkey, genotype 1, especially type 1b virus, causes approximately 90% of these infections, while types 2, 3, and 4 exist, albeit in low prevalences and are due to relatively recent and limited introductions. Two recent reports from Kayseri, a relatively large city in Central Anatolia, indicated unusually high prevalence for type 4 infections in the province reaching a 35% among patients admitted to hospitals for treatment of chronic hepatitis C. In this study, the origin, the demographic history, and the dynamic of the epidemic of unusual HCV genotype 4d in Turkey by using Bayesian coalescent-based method were investigated. A gene flow migration approach was also used to describe the synchronous geographical dispersal and genetic diversification of this unusual genotype in Kayseri province. The Turkish clade had a tMRCA of 44 years corresponding to the year 1967 and seems to have a different origin being completely segregated from the European one. Gene flow migration analysis indicated that Kayseri province appeared to be the epicenter of HCV-4d epidemic, exporting the infections. The demographic history of HCV-4d showed that the epidemic started in 1970s year then following a slow exponential growth until 1980s. The Turkish monophyletic clade suggests a segregate circulation of the epidemic in this region mostly due to unsafe parenteral medical procedures (with drug addiction playing a relatively negligible role).

Ombitasvir/ Paritaprevir/ Ritonavir + Ribavirin Combination Therapy in Hepatitis C Virus Infected Patients with Genotype 4 in Real-life Practice: A Multicentre Experience

“…This high proportion was significantly higher than the average prevalence of 1.4% reported for type 4 HCV infections in Turkey (15). It was shown recently that Kayseri genotype 4 isolates were closely related to subtype 4d sequences (13,16).…”

“…In Turkey, among HCV infections, genotype 1b was reported to be the most common one (90%), while types 2, 3, and 4 exist, with lower prevalence. However, recently, there has been an increase in HCV genotype 4 infections in Turkey (9)(10)(11)(12)(13). Two studies from Kayseri reported an unusually high proportion of genotype 4 infections reaching up to 35% among the patients, who were admitted to the hospitals for treatment of CHC (14,15).…”

The epidemic dynamics of hepatitis C virus subtypes 4a and 4d in Saudi Arabia

“…We note, however, that our subtype 4d dataset only offers limited insights and additional sampling efforts, in particular in the Horn of Africa (Sudan, Ethiopia, Eritrea and Somalia), are needed to shed light on the spatial dispersal patterns. Additional sampling is also required to evaluate the role of Saudi Arabia in the global HCV4d spatial circulation, and may prove useful in establishing the presence and nature of links with the 4d epidemics in Turkey58 and with the European 4d epidemic among injecting drug users and HIV-1 co-infected MSM2959.…”

The phylogenetic approach for viral infectious disease evolution and epidemiology: An updating review

“…HCV‐genotypes 1 and 3 are worldwide distributed . Genotypes 1 and 2 are endemic in Western African countries (Burkina Faso, Ghana, Guinea Bissau, Republic of Benin, and Nigeria) but sporadically found also in Italy, genotypes 1 and 4 predominates in the Democratic Republic of Congo and Gabon and genotype 4 in Central and Middle East Africa so as in Turkey . HCV genotype 3 is endemic in Asia (39% of all infections), where also genotype 6 is widely distributed in the Southeast regions .…”

“…[111][112][113] Both HCV genotypes and subtypes 114 are differently distributed around the world. 115 120,[125][126][127][128][129][130][131] HCV genotype 3 is endemic in Asia (39% of all infections), where also genotype 6 is widely distributed in the Southeast regions. 132 Genotype 5 is the most common HCV genotype in South Africa and in Belgium and genotype 7 has been detected only in Central African immigrants tested in Canada.…”