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HCV genotype-3h, a difficult-to-diagnose sub-genotype in the DAA era

Carmine Minichini, Mario Starace, Stefania De Pascalis, Margherita Macera, Laura Occhiello, Mara Caroprese, Martina Vitrone, Vincenzo Iovinella, Barbara Guerrera, Mario Masarone, Nicola Coppola

Corresponding author name: Nicola Coppola
Corresponding author e-mail: nicola.coppola@unicampania.it

Citation: Antiviral Therapy 2018; 23:605-609
doi: 10.3851/IMP3228

Date accepted: 06 February 2018
Date published online: 05 March 2018

Abstract

Background: No data are available on the clinical presentation and virological pattern in the case of failure of interferon (IFN)-free regimens in patients with genotype-3h. In this paper authors identified the virological and clinical characteristics of patients with genotype-3h treated with suboptimal or not indicated IFN-free regimens for the misclassification of HCV genotype.

Methods: A total of 87 consecutive patients with failure to an IFN-free regimen were re-tested for HCV genotype by HCV NS5B sequencing; the 26 patients identified as harbouring HCV-3 were enrolled.

Results: Of the 26 patients enrolled, 4 (15.4%) harboured sub-genotype-3h and 22 (84.6%) 3a. All patients were Italian. Patients with genotype-3a infection were younger (median age 56 years, range 47–78) compared to those with genotype-3h infection (median 74 years, range 65–79; P<0.006). With regard to the failed direct-acting antiviral (DAA)-regimens, three of the four patients with genotype-3h (75%) had been treated with an ineffective​ DAA regimen (paritaprevir, ombitasvir, dasabuvir ± ribavirin for 3 months) more frequently than those with genotype-3a (13.6%; P=0.02), because of previous erroneous identification of HCV-1 genotype. NS5A resistance-associated substitutions (RASs) were observed in 10 (45.4%) genotype-3a-infected patients and in 2 (50%) with genotype-3h. NS5B RASs were observed in only two genotype-3a-infected patients and in none of the 3h-infected patients.

Conclusions: This is the first time genotype-3h has been identified in Italian patients failing an IFN-free regimen, in the majority of cases because of a misclassification of the HCV genotype.

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