S3639 Two’s a Crowd: Case Report of Hepatitis C Genotype Mixed Pattern

Abstract

Introduction: We present a clinical case of an unusual laboratory abnormality, mixed pattern Hepatitis C genotype. The incidence of “mixed genotype HCV infections has been assessed across numerous geographical regions with estimates between 1.2% and 25.3% reported” (McNaughton et al, 2017, p. 524). This case highlights the importance of accurate identification of HCV genotype, subtype,and resistance-associated substitutions. Case Description/Methods: A 30-year-old male presented with a chief complaint of postprandial nausea/vomiting occurring daily for 3 weeks as well as episodes of heartburn and unintentional weight loss. He had a past history of substance abuse: intranasal and IV drug use of both heroin and cocaine. He tested positive for hepatitis C. There was remote use of alcohol (Cessation of use > 1 year),as well as a history of bipolar/depression, suicidal ideations, and self-mutilation. On physical examination BMI was 30.6. There were multiple body piercings. The liver was not palpable. Laboratory: Hepatitis C genotype-1B/3(method used: RT-PCR and reverse hybridization of the 5' UTR and core region of the HCV genome performed by Quest Diagnostics).Viral load-199,000 , Alk. Phos-86, AST-75, ALT-186, Tbil-0.5, PLT-238,000. Negative for HIV. Urine toxicology-positive for benzodiazepine& cocaine. Ultrasound elastography revealed F1 fibrosis. He was lost to care due to incarceration. Discussion: This case report highlights the unusual existence of mixed HCV genotype and the importance of accurate determination of viral genotypes and subtypes for determination of treatment with DAA. In this situation there tends to be a major and a minor genotype presumably because one is more replicatively fit. This may make selection of the appropriate DAA difficult and may explain some treatment failures.