Subgenotyping and genetic variability of hepatitis C virus in Palestine.

Sahar Rayan Da’As,Maysa Azzeh,Jason Blackard

doi:10.1371/journal.pone.0222799

Abstract

Hepatitis C virus (HCV) is a major cause of liver cirrhosis and hepatocellular carcinoma. Genotyping of HCV is crucial for successful therapy. To determine the HCV subgenotypes circulating in Palestine and to study the genetic variability of their core, we collected 84 serum samples which had tested positive for anti-HCV antibodies. Thirty-seven of these samples came from hemodialysis patients. Serum samples were subjected to viral RNA isolation and amplification of the HCV core gene. Thirty-three of the samples (39%) tested positive for HCV RNA. The HCV subgenotypes circulating in Palestine included 1a, 3a, and 4a, detected in 38%, 25%, and 22% of the samples, respectively. Furthermore, subgenotype 1b was present in three samples (9%), while the rare subgenotype 4v was present in two samples (6%). We identified a number of substitutions in the retrieved HCV core sequences, such as HCV 1b substitutions R70Q and M91L, which some studies have associated with hepatocellular carcinoma risk and poor virological response. In contrast to two previous studies reporting that HCV genotype 4 was predominant in the Gaza strip (present in just over 70% of samples), genotype 4 was detected in only 31% of the samples in our current study, whereas genotype 1 and 3 were present in 69% of samples. These differences may relate to the fact that many of our samples came from the West Bank and East Jerusalem. The co-circulation of different HCV genotypes and subgenotypes in Palestine suggests that subgenotyping prior to treatment is crucial in Palestinian patients.

Highlights

In 2015, one percent of the world population, or about 71 million people, were estimated to be infected with Hepatitis C virus (HCV), with 1.75 million new HCV infections [1]
While previous studies from Palestine described HCV genotypes circulating in Gaza strip only [7, 8], our study provides the first insight into HCV subgenotypes circulating throughout Palestine (West Bank, East Jerusalem, and Gaza strip) in the general population and in hemodialysis patients, and sheds light on the genetic variability of the core gene of these Palestinian HCV isolates
Of the HCV RNA positive sample, 12 came from the hemodialysis patient group (HD), and 21 came from the non-hemodialysis patients (HD) patients. (The HCV RNA negative samples might partially reflect false positives from the HCV antibody test, because we did not have the resources to retest the samples for HCV antibodies)

Summary

Introduction

In 2015, one percent of the world population, or about 71 million people, were estimated to be infected with HCV, with 1.75 million new HCV infections [1]. The predominant modes of HCV transmission were injection drug use and unsafe health-care practices [1]. One of the worst examples of the latter occurred in Egypt in the 1960s to 1980s, when insufficiently sterilized injection equipment use during anti-schistosomiasis treatment resulted in the catastrophic spread of HCV [2,3,4]. In 2015, the prevalence of antibody to HCV in Egypt was estimated as 10% and that of HCV RNA as 7%, which is the highest in the world [4].

Methods

Results

Conclusion