Department of Life Sciences, School of Science, University of Management and Technology, Lahore, Pakistan.
Genome Centre for Molecular Based Diagnostics and Research, Cl-25 Block B Al-Sudais Plaza, Abdalian Cooperative Society, Lahore, Pakistan.
Infect Genet Evol. 2018 Dec;66:66-71. doi: 10.1016/j.meegid.2018.09.003. Epub 2018 Sep 8.
To determine the genotypic distribution of HCV, frequency of risk factors involved in its transmission, and correlation of genotype with viral load in Mardan population which is the second largest city of Khyber Pakhtunkhwa (KPK), Pakistan. Blood samples of 1140 were collected from different regions of Mardan and major proportion of recruited patients were internally displaced people (IDPs), refugees, and slum dwellers. Complete patient's history was analyzed to assess the possible risks involved in HCV transmission. Viral genotype was determined by PCR (polymerase chain reaction) whereas, HCV RNA was measured by qRT-PCR. Data was analyzed using SPSS statistical software. Our results indicate 3a as the most abundant subtype in Mardan population followed by 3b, 2a, 2b, 4a, untypeable, mixed, 1a, and 1b. In contrast to previous findings, genotype 1 was the least prevalent genotype and the overall prevalence of HCV in Mardan population was significantly higher in females (n = 687, 60.2%) than males (n = 453, 39.7%). Significant difference between-genotypes and gender was observed in genotype 1 (p < .034) and genotype 3 (p < .004). The mean age was 44 (SD ± 9.51). The most frequently found mixed genotype was 3a + 1b and mixed genotype was more prevalent in males. The proportion of middle-aged people (41-49 years) was higher whereas, older and younger people were least infected with HCV. This is the first study that showed substantial correlation of genotype 3 with low and intermediate viral load in Mardan population. Moreover, high and extremely high viral load was associated with other genotypes. Our findings showed that most of the patients who experienced high and extremely high viremia in their blood were males and belonged to Takhat Bhai and Mardaan regions. There were significant difference in the prevalence of HCV genotype 3a (p = .001) and genotype 3b (p = .005) in different regions of Mardan. Pre-treatment viral load is significantly high (p 0.001) in tehsil Mardan patients infected with HCV genotype 3 as compared to other genotypes. Unsafe medical practices such as medical and dental surgeries, intravenous drug use, and blood transfusions were the main risk factors for HCV transmission in Mardan, KPK Pakistan. This study gives clear insights into the epidemiological status of HCV in Mardan population. Genotype 3 is correlated with low and intermediate viral load whereas high viral loads were revealed among patients infected with genotypes other than genotype 3. In the absence of better data and robust epidemiological information, this detailed analysis of HCV genotypes with special reference to risk factors, pretreatment viral load, gender, and age will provide the baseline data for development of optimal HCV eradication and preventive strategies.
为了确定 HCV 的基因分型分布、其传播涉及的危险因素频率以及基因型与马尔丹人群（巴基斯坦开伯尔-普赫图赫瓦省（KPK）的第二大城市）病毒载量的相关性。从马尔丹的不同地区采集了 1140 份血液样本，招募的患者主要是国内流离失所者（IDPs）、难民和贫民窟居民。分析了完整的患者病史，以评估 HCV 传播中可能涉及的风险。通过 PCR（聚合酶链反应）确定病毒基因型，通过 qRT-PCR 测量 HCV RNA。使用 SPSS 统计软件分析数据。我们的结果表明，3a 是马尔丹人群中最丰富的亚型，其次是 3b、2a、2b、4a、不可分型、混合、1a 和 1b。与之前的发现相反，基因型 1 是最不常见的基因型，马尔丹人群中 HCV 的总体流行率在女性（n=687，60.2%）中明显高于男性（n=453，39.7%）。在基因型 1（p<0.034）和基因型 3（p<0.004）中观察到基因型和性别之间存在显著差异。平均年龄为 44（SD+/-9.51）。最常见的混合基因型是 3a+1b，混合基因型在男性中更为普遍。中年人的比例较高，而老年人和年轻人感染 HCV 的比例最低。这是第一项表明 HCV 基因型 3 与马尔丹人群中低和中等病毒载量之间存在显著相关性的研究。此外，高和极高病毒载量与其他基因型相关。我们的研究结果表明，血液中高病毒载量和极高病毒载量的大多数患者是男性，来自塔哈特拜和马尔丹地区。在马尔丹不同地区，HCV 基因型 3a（p=0.001）和基因型 3b（p=0.005）的流行率存在显著差异。与其他基因型相比，感染 HCV 基因型 3 的马尔丹患者的治疗前病毒载量显著升高（p<0.001）。不安全的医疗实践，如医疗和牙科手术、静脉药物使用和输血，是 HCV 在巴基斯坦开伯尔-普赫图赫瓦省马尔丹传播的主要危险因素。这项研究清楚地揭示了 HCV 在马尔丹人群中的流行状况。基因型 3 与低和中等病毒载量相关，而高病毒载量则见于感染基因型 3 以外的其他基因型的患者。在缺乏更好的数据和稳健的流行病学信息的情况下，对 HCV 基因型进行详细分析，特别是参考危险因素、治疗前病毒载量、性别和年龄，将为制定最佳 HCV 消除和预防策略提供基线数据。
