Changes in the epidemiology of hepatitis C infection in Germany: shift in the predominance of hepatitis C subtypes.

Hepatitis C virus (HCV) subtype distribution was studied in 395 chronically infected patients from Germany. HCV genotype 1 was most frequent (80.5%). One hundred forty-three individuals (36.2%) were infected with subtype 1a and 175 (44.3%) were suffering from subtype 1b infection, respectively. HCV subtype 3a was found in 53 (13.42%) persons. Subtypes 2a, 2b, and 2c have been detected in 5 (1.27%), 10 (2.53%), and 4 (1.01%) individuals. Genotypes 4 and 5a accounted for HCV infections in 4 (1.01%) and 1 (0.25%) subjects. There was a notable variation in the distribution of the prevalent subtypes 1a and 1b in different age groups. Subtype 1a was detected in 53.3% and 68.0% of patients aged 1-10 and 11-20 years, whereas subtype 1b in the same groups was present only in 33.3% and 28.0% of patients, respectively. In contrast, in individuals older than 50 years subtype 1b was most frequent. Thus, subtype 1b has been gradually substituted for subtype 1a during the last 20 years. Logistic regression analysis with adjustment for sex and different modes of HCV acquisition demonstrated that age of the infected subjects was a direct explanatory variable for subtype 1a and 1b distribution. Therefore, the observed shift in HCV subtype prevalence could not be attributed to changes in the epidemiological relevance of different known risk factors of HCV transmission, as had been assumed in previous studies. The altered subtype pattern reported here may have a profound influence on the future epidemiology of HCV infection.