Molecular characterization of hepatitis C virus in liver disease patients in Botswana: a retrospective cross-sectional study

Lynnette Bhebhe,Max Essex,Pinkie Melamu,Chabeni C Banda,Zachary M Shaver,Jason T Blackard,Edward Zumbika,Sikhulile Moyo,Motswedi Anderson,Wonderful T Choga,Tshepiso Mbangiwa,Bonolo B Phinius,Rosemary M Musonda,Simani Gaseitsiwe,Sajini Souda

doi:10.1186/s12879-019-4514-1

Abstract

BackgroundHepatitis C virus (HCV) infection is a major cause of chronic liver disease globally. Direct acting antivirals (DAAs) have proven effective in curing HCV. However, the current standard of care (SOC) in Botswana remains PEGylated interferon-α (IFN-α) with ribavirin. Several mutations have been reported to confer resistance to interferon-based treatments. Therefore, there is a need to determine HCV genotypes in Botswana, as these data will guide new treatment guidelines and understanding of HCV epidemiology in Botswana.MethodsThis was a retrospective cross-sectional pilot study utilizing plasma obtained from 55 participants from Princess Marina Hospital in Gaborone, Botswana. The partial core region of HCV was amplified, and genotypes were determined using phylogenetic analysis.ResultsFour genotype 5a and two genotype 4v sequences were identified. Two significant mutations – K10Q and R70Q – were observed in genotype 5a sequences and have been associated with increased risk of hepatocellular carcinoma (HCC), while R70Q confers resistance to interferon-based treatments.ConclusionGenotypes 5a and 4v are circulating in Botswana. The presence of mutations in genotype 5 suggests that some patients may not respond to IFN-based regimens. The information obtained in this study, in addition to the World health organization (WHO) recommendations, can be utilized by policy makers to implement DAAs as the new SOC for HCV treatment in Botswana.

Highlights

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease globally
In Botswana, preliminary studies reported a low HCV seroprevalence of below 1% [6,7,8] Botswana is endemic for both human immunodeficiency virus (HIV) and hepatitis B
direct acting antivirals (DAA) can achieve sustained virologic responses (SVR) of 95 to 100% [9], have shortened treatment duration, and have overcome many challenges faced by administering interferon-based regimens

Summary

Introduction

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease globally. Direct acting antivirals (DAAs) have proven effective in curing HCV. In Botswana, preliminary studies reported a low HCV seroprevalence of below 1% [6,7,8] Botswana is endemic for both human immunodeficiency virus (HIV) and hepatitis B. Treatment of HCV has evolved rapidly with the introduction of direct acting antivirals (DAA) in the last decade. DAAs can achieve sustained virologic responses (SVR) of 95 to 100% [9], have shortened treatment duration, and have overcome many challenges faced by administering interferon-based regimens. Studies of circulating HCV genotypes are important prior to widescale treatment rollout [10].

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