Genotypes and viral load of hepatitis C virus among persons attending a voluntary counseling and testing center in Ethiopia

Abstract

The prevalence of different genotypes of hepatitis C virus (HCV) in Ethiopia is not known. HCV genotypes influence the response to therapy with alpha-interferon alone or in combination with ribavirin. A cross sectional study was conducted on attendees of voluntary counseling and testing center. Serum samples from 1,954 (734 HIV positive and 1,220 HIV negative) individuals were screened for HCV antibody. Active HCV infection was confirmed by quantitative PCR in 18 of the 71 samples with anti-HCV antibodies. The HCV viral load ranged from 39,650 to 9,878,341 IU/ml (median 1,589,631 IU/ml) with no significant difference [χ(2)(17) = 18.00, P = 0.389] between persons positive or negative for HIV. The viral load of HCV was, however, higher in older study subjects (r = 0.80, P = 0.000). HCV genotypes were determined using the VERSANT HCV Genotype Assay (LiPA) and sequence analysis of the NS5b region of the HCV genome. Diverse HCV genotypes were found including genotypes 1, 2, 4, and 5. There was no difference in the distribution regarding the HIV status. As in other parts of the world, genotyping of HCV must be considered whenever HCV is incriminated as a cause of hepatitis.

Non-epidemic HCV genotypes in low- and middle-income countries and the risk of resistance to current direct-acting antiviral regimens

“…Genotype 4a is the most prevalent genotype 4 HCV strain around the world and transmission was amplified in North Africa, particularly Egypt as a result of unsafe injection practices in healthcare settings (21). Clinical trials have focused on this subtype, and to a lesser extent genotype 4d, a strain introduced to Saudi Arabia during the early 20 th century (22), probably from countries in the Horn of Africa including Ethiopia (23). It has more recently emerged in PWID in Southern Europe and found a sexually-transmitted niche in men-who-have-sex-with-men (MSM) in Northern Europe with cross-over from PWID to MSM likely occurring in urban centres such as Amsterdam, London, Berlin and Paris (24).…”

“… 21 Clinical trials have focused on this subtype, and to a lesser extent genotype 4d, a strain introduced to Saudi Arabia during the early 20 th century, 22 probably from countries in the Horn of Africa including Ethiopia. 23 It has more recently emerged in PWID in Southern Europe and found a sexually-transmitted niche in men-who-have-sex-with-men (MSM) in Northern Europe with cross-over from PWID to MSM likely occurring in urban centres such as Amsterdam, London, Berlin and Paris. 24 While the globally dispersed genotype 4a and 4d lineages are well described, others prevalent in sub-Saharan Africa have only recently been investigated in clinical studies.…”

Genetic diversity of hepatitis C virus in Ethiopia

“…The high diversity and predominance of genotype 4 suggests that this genotype has been endemic for a longer time in Ethiopian population. A previous study also showed the dominance of this genotype in Ethiopia [21]. …”

“…The only study reporting on HCV genotypes in Ethiopia was limited to few patients attending a voluntary counseling and testing center in Addis Ababa. A total of 18 HCV RNA positive samples were analysed and a dominance of genotype 4 (50%, nine cases) followed by 2 (6 cases), 5 (2 cases) and 1 (1 case) was found [21]. However, no country-wide studies have been published and information on the HCV molecular diversity throughout the country is lacking.…”

The epidemic dynamics of hepatitis C virus subtypes 4a and 4d in Saudi Arabia

“…The absence of subtype 4d in surveillance studies in West Africa383940 and Central Africa9414243 suggests that this subtype may have emerged along a more eastward trajectory. Although subtype-level data from this region are scarce, the detection of HCV4d in 22% of seropositive samples in a small-scale Ethiopian survey44 supports such a scenario, as do the likely introduction of this subtype in southern Italy by returning colonists, of whom 82% were stationed in the Horn of Africa (Eritrea, Ethiopia and Somalia, the others inhabited Libya)45, and its high prevalence in Saudi Arabia1213.…”