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Abstract Details
Non-epidemic HCV genotypes in low- and middle-income countries and the risk of resistance to current direct-acting antiviral regimens
J Hepatol. 2021 May 8;S0168-8278(21)00310-X. doi: 10.1016/j.jhep.2021.04.045.Online ahead of print.
Rajiv Shah1, Lucrece Ahovegbe2, Marc Niebel1, James Shepherd1, Emma C Thomson3
Author information
1MRC-University of Glasgow Centre for Virus Research, Glasgow, UK.
2MRC-University of Glasgow Centre for Virus Research, Glasgow, UK; Mbarara University of Science and Technology, Mbarara, Uganda.
3MRC-University of Glasgow Centre for Virus Research, Glasgow, UK; London School of Hygiene and Tropical Medicine, London, UK. Electronic address: emma.thomson@glasgow.ac.uk.
Abstract
The hepatitis C virus (HCV) is an extremely diverse virus, subtypes of which are distributed variably around the world. Viral genotypes may be divided into epidemic subtypes; those that have become prevalent globally, and endemic subtypes that have a more limited distribution, mainly in Africa and Asia. The high variability of endemic strains reflects evolutionary origins in the locations where they are found. This increased genetic diversity raises the possibility of resistance to pan-genotypic direct acting antiviral regimens. While many endemic subtypes respond well to DAA therapies, others, for example genotypes 1l, 3b and 4r, do not respond as well as predicted. Many genotypes rare in high income countries but common in other parts of the world have not yet been fully assessed in clinical trials. Further sequencing and clinical studies in Sub-Saharan Africa and Asia are indicated to monitor response to treatment in order to facilitate the WHO 2030 elimination strategy.