Hepatitis C virus genotyping in Greece: Unexpected high prevalence of genotype 5a in a Greek island

Abstract

Hepatitis C virus (HCV) genotype 5 (G5) is a rare genotype reported mainly in South Africa. However, increasing data suggest the sporadic presence of this genotype in different European countries. To assess the epidemiology of HCV-G5 in Greece, genotyping was performed in 973 consecutive patients infected with HCV, referred to 7 hepatology centers throughout Greece, from January 2005 to December 2009. Genotype 5a (19 patients, 1.9%) was the fifth most prevalent genotype after genotype 1 (408 patients, 41.9%), genotype 3 (318 patients, 32.7%), genotype 4 (158 patients, 16.2%), and genotype 2 (70 patients, 7.2%). The majority of patients infected with G5 (16/19,84.2%) were referred to the General Hospital of Rhodes, an island in south-east Greece. The HCV genotype distribution in that particular island, indicates a particularly high G5 prevalence of 12.8%, after genotype 1 (40%), genotype 3 (28%), and genotype 4 (15%). Among the patients from Rhodes infected with G5 (n = 16), 13 (81.2%) were females. The mean age was 62.3 ± 6.5 years, significantly older than the patients infected with other HCV genotypes (mean age 40.6 ± 7.2, P< 0.0001). Nine out of the 16 cases (56.2%) presented features of high pre-treatment viral loads. Advanced liver fibrosis (Metavir F3-F4) was found in four out of five performed liver biopsies. Ten patients received treatment with pegylated interferon plus ribavirin and a sustained viral response were achieved in six cases. The source of infection is unknown but parenteral iatrogenic routes of transmission seem to have contributed significantly to the spread of genotype 5a in this region.

Eleven-Year Distribution Pattern of Hepatitis C Virus in Southern Italy

“…The source of infection is unknown but parenteral iatrogenic routes of transmission have contributed to infection [17]. …”

Aspects on the history of transmission and favor of distribution of viruses by iatrogenic action: perhaps an example of a paradigm of the worldwide spread of HIV

“…While in Greece HCV-5 has a prevalence of 1.9% (19/973), in Rhodes 13% (16/122) were found; 82% (13/16) of the patients infected with HCV-5a in Rhodes were females and the average age was 62 ± 6 years [19]. The iatrogenic route of genotype 5a, that is usually prevalent in Southern Africa, could fairly be linked to dental or surgical interventions.…”

“…In Congo-Kinshasa a cohort of 299 males was investigated, 13.7% (41/299) of the patients were seropositive and 3.7% (11/299) viraemic; age correlation revealed that 13.7% (10/73) of those older 50, and 0.5% (1/211) younger 50 years were viraemic. The HCV genotypes were 4c, 4k, 4l and 4r and thus it was concluded that different separate HCV epidemics by parenteral injections, iatrogenic or another unidentified routes in the mid-twentieth century caused this epidemic [19, 21]. In a more recent study of 839 participants 26% (217/839) were anti-HCV positive and genotype distribution of 4k and 4r was detected in hospital A, with a risk factor of intramuscular and intravenous injection therapy for tuberculosis, while genotype 4k in hospital B in Kinshasa was associated with injection of anti-malarias.…”

Hepatitis C Virus Genotype 5

“…2 HCV genotype 5 (HCV-5) is mainly restricted to South Africa, where it accounts for up to 40% of the overall HCV. 12,13 We recently reported a cluster of HCV-5-infected patients in southeast Greece and described their clinical and epidemiological characteristics. [5][6][7][8][9][10][11] In Greece, prevalence of HCV-5 has been estimated to be 0.4% to 1.9%.…”

“…3,4 However, sporadic presence of HCV-5 has been reported in other parts of the world including France, Belgium, Canada, Syria, Spain, Germany, and Brazil. 12 Briefly, patients infected with HCV-5 were mostly females of advanced age showing high levels of viremia and advanced hepatic fibrosis. 12,13 We recently reported a cluster of HCV-5-infected patients in southeast Greece and described their clinical and epidemiological characteristics.…”