To describe the spread of hepatitis C virus (HCV) among HCV/human immunodeficiency virus (HIV)-coinfected injection drug users (IDUs), the molecular epidemiology of HCV was studied among 108 IDUs from 7 European countries. Phylogenetic analysis based on the NS5B region showed great sequence variation of HCV within each country and no clear phylogenetic clustering by geographic region. The most prevalent subtypes were 1a and 3a, but the percentage of genotype 4 was also relatively high, ranging from 7% in northern Europe to 24% in southern Europe. Genotype 4 consisted mainly of subtype 4d and has entered the majority of the IDU populations studied. The significantly lower evolutionary distances within subtype 4d suggest that this subtype may have entered the European IDU population relatively recently. In conclusion, HCV exchange between European IDU populations has occurred on a large scale, and, overall, country-specific clustering for HCV was less than that shown for HIV.

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Spread of Hepatitis C Virus among European Injection Drug Users Infected with HIV: A Phylogenetic Analysis

Hepatitis C virus (HCV) is a major aetiological agent of chronic hepatitis and it may lead to the development of liver cirrhosis and hepatocellular carcinoma. HCV has been classified into six clades as a result of high genetic variability. A commercial procedure to genotype HCV in 678 patients from Carlos Haya Regional University Hospital, Malaga was used to study the distribution of HCV genotypes in Malaga, southern Spain. A high prevalence of HCV-4 (10.2%) was found. This genotype is found more commonly in Egypt, Central Africa and the Middle East. The distribution of the different subtypes in the 69 patients with HCV-4 was as follows: 4.3% subtype 4e, 7.2% subtype 4a, 11.5% not subtypable, and 76.8% subtype 4c/4d. Of the 53 4c/4d patients, 69% were intravenous drug users and 31% non-intravenous drug users. In order to characterise further the HCV-4c/4d patients, sequences of the non-structural 5B gene (393 bp) were obtained from 36 HCV-4c/4d-infected untreated patients. Phylogenetic tree topologies distinguished clearly the two subtypes: 11 patients were infected by subtype 4c and 25 by 4d. This phylogenetic analysis, reinforced by the epidemiological characteristics, suggests the extension of the HCV-4c and -4d subtypes in the area of Malaga among both intravenous drug users and non-intravenous drug users.

High prevalence of hepatitis C virus subtypes 4c and 4d in Malaga (Spain): Phylogenetic and epidemiological analyses

Objective: The object of this study is to determine the molecular epidemiology of hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA). Method: Four hundred and ninety-two histological proven chronic HCV patients prospectively recruited from all regions of KSA, between November 1999 and March 2002, were genotyped and subtyped using amplified products of specific primers from the 5-UTR region in a reverse transcription polymerase chain reaction (Roche Diagnostics, Switzerland) followed by a reverse hybridization technique (Innolipa HCV II [Innogenetics, Belgium]). Results: Sixty-two percent of Saudis were found to be genotype 4. Other genotypes were 1 (24.1%); 2 (7.4%); 3 (5.9%); 5 (0.3%); and 10 (0.3%). There were no differences in distribution patterns between sexes and ages. All regions showed similar distribution except the Eastern region where subtype 2a/c seem to have emerged. Diabetic patients and those with a history of blood transfusion had the same pattern as those with community acquired HCV. Among the non-Saudis (mostly Egyptians), genotype 4 predominated (88%).) Conclusion: We conclude that 86% of Saudi chronic hepatitis C cases are due to genotypes 1 and 4. Since these are considered difficult to treat an aggressive approach to management using combination therapy of pegylated interferon plus ribavirin for 48 weeks should be considered for all cases of chronic hepatitis C until genotyping proves otherwise.

Hepatitis C genotypes/subtypes among chronic hepatitis patients in Saudi Arabia : Hepatitis C Infections


Hepatitis C virus genotypes have been associated with specific geographical areas and in many cases with specific mode of transmission. In developed countries, genotype determination has formed a part of the management of patients with hepatitis C virus seropositivity and liver diseases due to hepatitis C virus. The epidemiology of hepatitis C virus has been shown to be changing rapidly in many countries due to population movement and different life-styles; hence the distribution of the genotypes is being monitored closely in many countries. In the Kingdom of Saudi Arabia, there are only a handful of publications recording the hepatitis C virus genotypes in various population groups. These studies have been carried out mainly in Riyadh (Central province) and Jeddah (Western province). There are no studies emanating from the Eastern or Northern provinces. According to these studies, the most prevalent genotype in the Western Province and probably in the whole Kingdom of Saudi Arabia was genotype 4, followed by genotypes 1a and 1b. Genotypes 1, 2a,/2b, 3 and 6 are very rare in the Kingdom of Saudi Arabia. Genotype 5 was identified exclusively in the Western province and nowhere else. Genotypes 1b and 4 were associated with different histological grades of liver disease. Mixed infections with more than one genotype were observed in some studies. More detailed epidemiological studies of hepatitis C virus infections are needed in the Kingdom of Saudi Arabia to gain more insight into a possible type/subtype-specific pathogenesis of hepatitis C virus in the different regions of the Kingdom of Saudi Arabia as well as the distribution of the genotypes in the various localities.

https://smj.org.sa/content/smj/23/1/7.full.pdf

Hepatitis C virus genotypes in Saudi Arabia.

OBJECTIVES 
The object of this study is to determine the molecular epidemiology of hepatitis C virus (HCV) in the Kingdom of Saudi Arabia (KSA).
 METHODS 
Four hundred and ninety-two histological proven chronic HCV patients prospectively recruited from all regions of KSA, between November 1999 and March 2002, were genotyped and subtyped using amplified products of specific primers from the 5-UTR region in a reverse transcription polymerase chain reaction (Roche Diagnostics, Switzerland) followed by a reverse hybridization technique (Innolipa HCV II [Innogenetics, Belgium]).
 RESULTS 
Sixty-two percent of Saudis were found to be genotype 4. Other genotypes were 1 (24.1%); 2 (7.4%); 3 (5.9%); 5 (0.3%); and 10 (0.3%). There were no differences in distribution patterns between sexes and ages. All regions showed similar distribution except the Eastern region where subtype 2a/c seem to have emerged. Diabetic patients and those with a history of blood transfusion had the same pattern as those with community acquired HCV. Among the non-Saudis (mostly Egyptians), genotype 4 predominated (88%).
 CONCLUSIONS 
We conclude that 86% of Saudi chronic hepatitis C cases are due to genotypes 1 and 4. Since these are considered "difficult to treat" an aggressive approach to management using combination therapy of pegylated interferon plus ribavirin for 48 weeks should be considered for all cases of chronic hepatitis C until genotyping proves otherwise.

Hepatitis C genotypes/subtypes among chronic hepatitis patients in Saudi Arabia.

Hepatitis C virus (HCV) genotype 4 is believed to be predominant in the Middle East including Saudi Arabia (SA). We attempted to genotype 80 HCV isolates from different parts of SA by direct sequencing of a variable 222bp fragment from the NS5B region. The phylogenetic analysis of the NS5B sequences was complemented by direct sequence analysis of the conserved 5'-NCR region for HCV type-specific polymorphism. All 80 NS5B sequences separated into 3 clades which comprised 6 type 1b variants, 30 type 4 variants (24 of type 4a and 6 of type 4c or d) and 44 type 3 variants. Apart from two definitive type 3b variants the other 42 type 3 NS5B sequences formed 4 clusters with low similarity to type 3a-f HCV sequences from the database. The precise subtyping of these 42 type 3 variants awaits sequencing of longer HCV RNA stretches. Our results indicate that HCV type 4 may not be the only dominant genotype in SA.

A. I. Al-Aska

Papers

Is hepatitis C virus genotype 4 predominant in Saudi Arabia