Clinical significance of hepatitis C virus genotypes

The advent of genotyping assays has stimulated investigators around the world to study the molecular epidemiology of hepatitis C virus (HCV) infection in specific patient categories, as well as possible correlations with the clinical and histological features of chronic liver disease and response to antiviral treatment. While a general consensus has been reached on the Worldwide epidemiology and distribution of HCV types in certain risk categories (i.e. intravenous drug users), the association between genotype 1b and severe liver disease is still controversial. Although generalized use of genotyping is not presently recommended for clinical or epidemiological monitoring, several studies emphasize to the importance of HCV genotyping as part of a therapeutic algorithm. This recommendation is based on overwhelming evidence in support of a correlation between genotype 1 and a poor response to interferon-a alone or in combination with ribavirin

Antibody-negative chronic hepatitis C virus infection in immunocompetent children

Antibody-negative hepatitis C virus (HCV) infection, defined by the presence of HCV viremia in the absence of a serological response to HCV, was detected in two immunocompetent and symptom-free children; each had a history of exposure to blood products. HCV infection may occasionally explain cryptogenic elevation of aminotransferases, even in he absence of serum anti-HCV. HCV-RNA shoud be investigated in these cases, particularly in the presence of previous exposure to blood products

Hepatitis C virus genotype 1b as a major risk factor associate with hepatocellular carcinoma in cirrhotic patients: a seventeen-year prospective study

Hepatocellular carcinoma (HCC) is the most frequent cause of death in patients with hepatitisC virus (HCV)–induced cirrhosis. Despite a number of studies in different populations worldwide suggesting an association between HCV genotype 1 and the risk of HCC, no consensus has emerged yet on this matter, which is still controversial. In an attempt to clarify this issue, a prospective study of 163 consecutive HCV-positive patients with cirrhosis, who were enrolled between January 1989 and December 1990, was carried out. HCC occurrence was detected by ultrasound surveillance every 6 months. Independent predictors of HCC were assessed with a Cox regression analysis. After a median follow-up of 10.7 years, 44 [4.26/100/year, confidence interval (CI) _ 3.11-5.68/100/year] of 104 patients infected with genotype 1b developed HCC versus 10 (1.69/100/year, CI_0.82-3.09/100/year) of 52 patients infected with genotype 2a/c (P _ 0.0001). Multivariate analysis showed that HCV genotype 1b was independently associated with HCC development [hazard ratio (HR) _ 3.02, 95% CI _ 1.40-6.53]. Other predictors of HCC were esophageal varices (HR _ 2.15, 95% CI_1.03-4.47), male gender (HR_2.12, 95% CI_1.10-4.11), and age over 60 years (HR _ 5.96, 95% CI _ 1.23-28.8). Conclusion: HCV genotype 1b is associated with a statistically significant higher risk of developing HCC. Patients with cirrhosis that are infected with this genotype require more intensive surveillance for the early detection and aggressive management of neoplasia