Minichini Carmine, Starace Mario, De Pascalis Stefania, Macera Margherita, Occhiello Laura, Caroprese Mara, Vitrone Martina, Iovinella Vincenzo, Guerrera Barbara, Masarone Mario, Coppola Nicola
Infectious Diseases Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania L. Vanvitelli, Naples, Italy.
Internal Medicine, University of Campania & AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
Antivir Ther. 2018;23(7):605-609. doi: 10.3851/IMP3228. Epub 2018 Mar 5.
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.
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.
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.
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.
关于基因3h型患者无干扰素方案治疗失败后的临床表现和病毒学模式尚无数据。在本文中，作者确定了因丙型肝炎病毒（HCV）基因型错误分类而接受次优或不适用的无干扰素方案治疗的基因3h型患者的病毒学和临床特征。
对87例连续的无干扰素方案治疗失败的患者通过HCV NS5B测序重新检测HCV基因型；纳入26例被鉴定为携带HCV-3的患者。
在纳入的26例患者中，4例（15.4%）携带3h亚型，22例（84.6%）携带3a亚型。所有患者均为意大利人。与基因3h型感染患者（中位年龄74岁，范围65-79岁；P<0.006）相比，基因3a型感染患者更年轻（中位年龄56岁，范围47-78岁）。关于失败的直接抗病毒药物（DAA）方案，4例基因3h型患者中有3例（75%）接受了无效的DAA方案（帕立普韦、奥比他韦、达沙布韦±利巴韦林治疗3个月），比基因3a型患者（13.6%）更频繁（P=0.02），原因是之前对HCV-1基因型的错误鉴定。在10例（45.4%）基因3a型感染患者和2例（50%）基因3h型感染患者中观察到NS5A耐药相关替代（RASs）。仅在2例基因3a型感染患者中观察到NS5B RASs，而在3h型感染患者中未观察到。
这是首次在意大利无干扰素方案治疗失败的患者中鉴定出基因3h型，在大多数情况下是由于HCV基因型的错误分类。
