Comparative Study Of Patients With Chronic Hepatitis C Virus Infection Due To Genotypes 1 And 3 Referred For Treatment In Southeast Brazil

Background: The progression of liver disease in patients with chronic hepatitis C virus (HCV) infection is influenced by host and viral factors. Distinct clinical outcomes in patients infected with different HCV genotypes have been described in the literatute. However, the association between specific HCV genotype and clinical outcome remains unclear. We set out to study the natural history of HCV genotype 1 and 3 infections in Campinas, São Paulo state, Brazil, focusing on epidemiological, clinical, biochemical, and histological characteristics. Methods: Patients with HCV infection referred for treatment between January 2003 and December 2006 were included in this study. We collected epidemiological, clinical, and laboratorial data using standard forms. Results: A total of 283 patients were included; genotype 1 was idenfied in 163 (57.6%) patients, genotype 3 in 112 (39.6%), genotype 2 in 7 (2.5%), and genotype 4 in 1 (0.35%). Patients with genotype 2 and 4 were excluded from analysis. Multivariate analysis showed that intravenous energetic drug, positive cryoglobulin, and cirrhosis were independently and significantly associated with HCV genotype 3 (p < 0.05). Conclusion: Genotype 3 currently seems to be associated with intravenous energetic drug, high frequency of cryoglobulinemia, and advanced liver disease in our region. Understanding the distribution of the different HCV genotypes can elucidate transmission of HCV and support optimal prevention strategies. © 2008 Vigani et al; licensee BioMed Central Ltd.8Armstrong, G.L., Alter, M.J., McQuillan, G.M., The past incidence of hepatitis C virus infection: Implications for the future burden of chronic liver disease in the United States (2000) Hepatology, 31, pp. 777-782. , 10.1002/hep.510310332 10706572Consensus Statement (1999) J Hepatol, 30, pp. 956-961. , EASL International Consensus Conference on Hepatitis C 10.1016/ S0168-8278(99)80154-8 10365827Treatment of hepatitis C. Guidelines (2002) Gastroenterol Clin Biol, 26, pp. B312-B320. , Consensus ConferenceCodes, L., Freitas, L.A.R., Santos-Jesus, R., Comparative study of Hepatitis C virus genotypes 1 and 3 in Salvador, Bahia (2003) Braz J Infect Dis, 7, pp. 409-417. , 10.1590/S1413-86702003000600009 14636481Silva, G.F., Nishimura, N.F., Coelho, K.I.R., Soares, E.C., Grading and staging chronic hepatitis C and its relation to genotypes and epidemiological factors in Brazilian blood donors (2005) Braz J Infect Dis, 9, pp. 142-149. , 16127590Alberti, A., Chemello, L., Bevebnú, L., Natural history of hepatitis C (1999) J Hepatol, 31, pp. 17-24. , 10.1016/S0168-8278(99)80369-9 10622555Poynard, T., Bedossa, P., Opolon, P., Natural history of liver fibrosis progression in patients with chronic hepatitis C (1997) The Lancet, 349, pp. 825-832. , 10.1016/S0140-6736(96)07642-8Simmonds, P., Viral heterogeneity of the hepatitis C virus (1999) J Hepatol, 31 (SUPPL. 1), pp. 54-60. , 10.1016/S0168-8278(99)80375-4 10622561Zein, N.N., Rakela, J., Krawitt, E.L., Hepatitis C virus genotypes in the United States: Epidemiology, pathogenicity, and response to interferon therapy (1996) Ann Intern Med, 125, pp. 634-639. , 8849147McOmish, F., Yap, P.L., Dow, B.C., Geographical distribution of hepatitis C virus genotypes in blood donors: An international collaborative survey (1994) J Clin Microbiol, 32, pp. 884-892. , 263157 7913097Zein, N.N., Clinical significance of hepatitis C genotypes (2000) Clin Microbiol Rev, 13, pp. 223-235. , 100152 10755999 10.1128/CMR.13.2.223-235.2000Bedossa, P., Poynard, T., An algorithm for the grading of activity in chronic hepatitis C (1996) Hepatology, 24, pp. 289-293. , The METAVIR cooperative study group 10.1002/hep.510240201 8690394Simmonds, P., Genetic diversity and evolution of hepatitis C virus - 15 years on (2004) J Gen Virol, 85, pp. 3173-3188. , 10.1099/vir.0.80401-0 15483230Campiotto, S., Pinho, J.R.R., Carrilho, F.L., Geographic distribution of hepatitis C virus genotypes in Brazil (2005) Braz J Med Biol Res, 38, pp. 41-49. , 10.1590/S0100-879X2005000100007 15665987Pawlotsky, J.M., Tsakiris, L., Roudot-Thoraval, E., Relationship between hepatitis C virus genotypes and sources of infection in patients with chronic hepatitis C (1995) J Infect Dis, 171, pp. 1607-1610. , 7769300Liakina, V., Speiciene, D., Irnius, A., Prevalence of cryoglobulinemia in patients with chronic HCV infection (2002) Med Sci Monit, 8 (1), pp. CR31-CR36. , 11782678Frangeul, L., Musset, L., Cresta, P., Hepatitis C virus genotypes and subtypes in patients with hepatitis C, with and without cryoglobulinemia (1996) J Hepatol, 25, pp. 427-432. , 10.1016/S0168-8278(96)80200-5 8912140Willems, M., Sheng, L., Roskams, T., Hepatitis C virus and its genotypes in patients suffering from chronic hepatitis C with or without a cryoglobulinemia-related syndrome (1994) J Med Virol, 44, pp. 266-271. , 10.1002/jmv.1890440310 7531756Zehender, G., De Maddalena, C., Bernini, F., Compartmentalization of hepatitis C virus quasispecies in blood mononuclear cells of patients with mixed cryoglobulinemic syndrome (2005) J Virol, 79, pp. 9145-9156. , 1168762 15994809 10.1128/JVI.79.14.9145-9156.2005Parise, E.R., de Oliveira, A.C., Ferraz, M.L., Cryoglobulinemia in chronic hepatitis C: Clinical aspects and response to treatment with interferon alpha and ribavirin (2007) Rev Inst Med Trop S Paulo, 49, pp. 67-72. , 10.1590/S0036-46652007000200001 17505661Silini, E., Bottelli, R., Hepatitis C virus genotypes and risk of hepatocellular carcinoma in cirrhosis: A case control study (1996) Gastroenterology, 111 (1), pp. 1999-2005. , 10.1053/gast.1996.v111.pm8698200Zeuzem, S., Franke, A., Lee, J.H., Phylogenetic analysis of hepatitis C virus isolates and their correlation to viremia, liver function tests, and histology (1996) Hepatology, 24, pp. 1003-1009. , 10.1002/hep.510240505 8903367Manns, M.P., McHutchison, J.G., Gordon, S.C., Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: A randomised trial (2001) Lancet, 358, pp. 958-965. , 10.1016/S0140-6736(01)06102-5 11583749Fried, M.W., Shiffman, M.L., Reddy, K.R., Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection (2002) N Engl J Med, 26 (347), pp. 975-982. , 10.1056/NEJMoa02004