Abstract

BackgroundApproximately 10 million people in Pakistan are infected with the hepatitis C virus (HCV). Most patients develop chronic hepatitis, with rare cases of spontaneous clearance. However, little is known about multidrug resistant viral variants in Pakistan.FindingsThis case study describes a 47-year-old male diagnosed with chronic HCV genotype 3a infection in 2003. After an initial diagnosis of viral infection, the patient remained treatment naïve for 5 years. He received two therapy cycles of interferon (IFN) plus ribavirin (RBV) in 2007 and 2010, however, he was non-responsive to the therapy. The patient then received an additional two treatment cycles of pegylated IFN α-2b plus RBV (in 2011 and 2013); he was still non-responsive. In 2016, the patient underwent sofosbuvir plus RBV combination therapy, however, the sustained virological response was still not achieved. The host genetic factor was found to be heterozygous guanine and thymine (GT) and cytosine and thymine (CT) genotypes of rs8099917 and rs12979860 polymorphism of IL28B, respectively. Phylogenetic analysis suggests that the resistant variant belong to an out-group and may require triple therapy.ConclusionsThis is the first case that reports on a HCV-infected individual who was a non-responder to multiple IFN therapies in Pakistan. Further studies are needed to understand multidrug-resistant HCV variants in the Pakistani population.

Highlights

  • 10 million people in Pakistan are infected with the hepatitis C virus (HCV)

  • This is the first case that reports on a HCV-infected individual who was a non-responder to multiple IFN therapies in Pakistan

  • In treatment-naïve patients infected with genotype 1, phase 2 trials of 400 mg/day of pegylated interferon (PEG-IFN), RBV, and SOF for 12 or 24 weeks resulted in Sustained virological response (SVR) of 87–92% [15, 16]

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Summary

Introduction

10 million people in Pakistan are infected with the hepatitis C virus (HCV). A single infected HCV patient can have a mixture of closely related viral genomes, either as quasispecies or separate groups referred to as genotypes [1]. Patients infected with HCV genotypes 2 and 3 respond more efficiently to IFN-based therapies than those infected with a Sofosbuvir (SOF) is one of the direct-acting antivirals (DAAs) approved by the U.S Food and Drug Administration (US-FDA). It was approved on December 6, 2013 [13, 14]. In treatment-naïve patients infected with genotype 1, phase 2 trials of 400 mg/day of PEG-IFN, RBV, and SOF for 12 or 24 weeks resulted in SVRs of 87–92% [15, 16]

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