Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.
Nuclear Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan.
Infect Dis Poverty. 2018 Feb 11;7(1):11. doi: 10.1186/s40249-018-0386-7.
Approximately 10 million people in Pakistan are infected with the hepatitis C virus (HCV). Most patients develop chronic hepatitis, with rare cases of spontaneous clearance. However, little is known about multidrug resistant viral variants in Pakistan.
This case study describes a 47-year-old male diagnosed with chronic HCV genotype 3a infection in 2003. After an initial diagnosis of viral infection, the patient remained treatment naïve for 5 years. He received two therapy cycles of interferon (IFN) plus ribavirin (RBV) in 2007 and 2010, however, he was non-responsive to the therapy. The patient then received an additional two treatment cycles of pegylated IFN α-2b plus RBV (in 2011 and 2013); he was still non-responsive. In 2016, the patient underwent sofosbuvir plus RBV combination therapy, however, the sustained virological response was still not achieved. The host genetic factor was found to be heterozygous guanine and thymine (GT) and cytosine and thymine (CT) genotypes of rs8099917 and rs12979860 polymorphism of IL28B, respectively. Phylogenetic analysis suggests that the resistant variant belong to an out-group and may require triple therapy.
This is the first case that reports on a HCV-infected individual who was a non-responder to multiple IFN therapies in Pakistan. Further studies are needed to understand multidrug-resistant HCV variants in the Pakistani population.
在巴基斯坦，约有 1000 万人感染丙型肝炎病毒（HCV）。大多数患者发展为慢性肝炎，极少数情况下可自发清除。然而，关于巴基斯坦多药耐药病毒变异体的信息知之甚少。
本病例研究描述了一名 47 岁男性，他于 2003 年被诊断患有慢性丙型肝炎基因型 3a 感染。在最初诊断为病毒感染后，该患者在 5 年内仍未接受治疗。他于 2007 年和 2010 年接受了两次干扰素（IFN）加利巴韦林（RBV）治疗周期，但对治疗无反应。随后，该患者接受了另外两次聚乙二醇干扰素 α-2b 加 RBV 治疗周期（2011 年和 2013 年）；他仍然没有反应。2016 年，该患者接受了索非布韦加 RBV 联合治疗，但仍未达到持续病毒学应答。宿主遗传因素被发现是杂合鸟嘌呤和胸腺嘧啶（GT）和胞嘧啶和胸腺嘧啶（CT）基因型的 rs8099917 和 rs12979860 多态性的 IL28B。系统发育分析表明，耐药变异体属于外群，可能需要三联治疗。
这是首例报告在巴基斯坦，一名 HCV 感染患者对多次 IFN 治疗无反应的病例。需要进一步研究来了解巴基斯坦人群中多药耐药 HCV 变异体。
