The Prevalence of Mixed Hepatitis C Virus Genotype Infection and Its Effect on the Response to Direct-Acting Antivirals Therapy

Abstract

Background: The incidence of mixed hepatitis C virus (HCV) genotype infection is variable, and a few reports exist regarding the efficacy of direct-acting antivirals (DAA) therapy for mixed genotype. We aimed to investigate the prevalence of mixed genotype and its impact on the virologic response to DAA therapy. Methods: A total of 365 patients with chronic HCV infection who completed antiviral therapy were recruited. Nested polymerase chain reaction with universal and specific primers of genotypes 1b and 2 and direct sequencing were used for HCV genotyping. Results: Direct sequencing with universal primers defined genotypes 1b (n = 230), 2a (n = 95), and 2b (n = 40). Direct sequencing of genotype 2 was performed in patients with genotype 1b, and direct sequencing of genotype 1b in patients with genotype 2. Four patients with genotype 1b underwent amplification for genotype 2, and direct sequencing identified genotypes 1b (n = 1), 2a (n = 1), and 2b (n = 2). None with genotype 2 underwent amplification for genotype 1b. Three cases were confirmed to have mixed genotype. Conclusions: Mixed genotype was rare, and hence the impact of mixed genotype on treatment outcome with DAA therapy is expected to be minimal.

Geographic Distribution of HCV Genotypes and Efficacy of Direct-Acting Antivirals in Chronic HCV-Infected Patients in North and Northeast China: A Real-World Multicenter Study

“…It is well recognized that mixed genotype is more common in patients with repeated HCV exposures [15,16]. Recently, patients with mixed infection were paid more concern with the development of detection methods [15,17,18]. Di erent patterns of mixed infection had been reported in China, such as 1b/2a, 1b-2k, 6a/2a, 6a/1a, 1b-2k, 3-6, and so on, of which the most common in China was 1b/2a [7,19].…”

Comparison of diagnostic performance among Abbott RealTime HCV Genotyping II, Abbott HCV Genotype plus RUO, and Roche Cobas HCV Genotyping assays for hepatitis C virus genotyping

“…Accurate detection of mixed HCV infections is crucial for effective clinical diagnosis 25 . Our study demonstrated that both assays generally can effectively confirm mixed HCV infections when the minor genotypes exceeded approximately 8.4% of the viral load.…”

Pan-Genotypic Direct-Acting Antiviral Agents for Undetermined or Mixed-Genotype Hepatitis C Infection: A Real-World Multi-Center Effectiveness Analysis

“…Genotype 3 was commonly found in drug abusers. Determination of HCV genotype requires the use of PCR to hybridize to genotype-specific probe that allows understanding route of HCV infection of the patient and helps clinicians to determine the duration of interferon therapy [ 2 , 6 ] or choosing genotype-specific DAA therapy before the introduction of current pan-genotypic DAA therapy [ 14 , 18 , 19 , 32 ]. However, less than ten percent of the patients were infected with the mixed variant of the HCV, especially those infected with HIV or intravenous drugs users [ 17 , 21 , 33 , 34 , 35 ].…”

“…The 2020 EASL [ 14 ] and 2019 AASLD [ 15 , 16 ] treatment guidelines now suggest two main regimens for treatment-naïve patients, i.e., glecaprevir (300 mg)/pibrentasvir (120 mg) (GLE/PIB), and sofosbuvir (400 mg)/velpatasvir (100 mg) (SOF/VEL) with pan-genotypic antiviral activity to simplify the treatment algorithm. A minority of the patients may get infected with a mixed HCV genotype [ 17 , 18 , 19 ] or the HCV genotype that was undetermined by conventional polymerase chain reaction (PCR) techniques [ 20 , 21 ]. To date, there is a paucity of real-world data on the effectiveness and safety of pan-genotypic DAAs for patients with these two specific scenarios for HCV elimination [ 17 , 18 , 19 ].…”

“…A minority of the patients may get infected with a mixed HCV genotype [ 17 , 18 , 19 ] or the HCV genotype that was undetermined by conventional polymerase chain reaction (PCR) techniques [ 20 , 21 ]. To date, there is a paucity of real-world data on the effectiveness and safety of pan-genotypic DAAs for patients with these two specific scenarios for HCV elimination [ 17 , 18 , 19 ]. Thus, this study aimed to evaluate the real-world safety and efficacy of pan-genotypic DAA in patients with mixed-genotype or genotype-undetermined HCV from the five hospitals in the Changhua Christian Care System.…”