The heterogeneity of hypervariable region 1 (HVR1), located at the amino terminus of the E2 envelope, may be involved in resistance to alpha interferon (IFN-␣) treatment. We investigated whether peculiar HVR1 domain profiles before treatment were associated with the maintenance of sensitivity or the appearance of resistance to treatment. Fifteen patients infected with hepatitis C virus genotype 1b and treated with IFN with or without ribavirin were selected. Ten responded to treatment (groups R1 and R2) and five did not (group NR). The amino acid sequences of 150 naturally occurring HVR1 variants present in the serum before therapy were compared in relation to treatment outcome. HVR1 variants from the NR group contained a constant nonantigenic amino acid segment that was not found in HVR1 variants from the R groups.Hepatitis C virus (HCV) infection leads to viral persistence and chronic disease in 50 to 70% of cases. A significant proportion of chronically infected patients subsequently develop cirrhosis and hepatocellular carcinoma. The high prevalence of HCV infection in the general population, the absence of documented spontaneous recovery from chronic infection, and the potentially serious complications make treatment with alpha interferon (IFN-␣) or a combination of ribavirin and IFN-␣ necessary. However, the virological response is sustained in less than 20% of patients treated with IFN-␣ alone and in 40 to 45% of patients given combination therapy (30). The antiviral response is determined by the HCV genotype and the viral load: the frequency of the long-term response to IFN treatment is higher for patients infected with genotypes 2 and 3 than for those infected with genotype 1 (20). The covalent attachment of IFN-␣ to polyethylene glycol (pegylated interferon) increases its half-life and improves the overall effectiveness of treatment, although there is still a significant difference in the overall effectiveness of treatment for patients infected with different genotypes (44).In infected individuals, HCV exists as pools of related genetic variants, referred to as quasispecies (3). The genes encoding the envelope glycoproteins (E1 and E2) are the most heterogeneous, especially the 81 nucleotides encoding hypervariable region 1 (HVR1) of E2 (24). Therefore, HVR1 can be used both to identify individual viral strains and to study HCV quasispecies. HVR1 is predicted to be flexible and well exposed (40). HVR1 contains linear B-cell epitopes and is thought to be the major immunogenic domain of E2 (39), although other B-cell epitopes outside of HVR1 have also been identified (16). There is considerable evidence suggesting that HVR1 plays a functional role in the attachment and entry of HCV into target cells: (i) anti-HVR1 monoclonal antibodies inhibit the attachment of HCV to human T cells in vitro (45), (ii) rabbit hyperimmune serum directed against the C terminus of HVR1 neutralizes HCV infectivity in chimpanzees (5), and (iii) only small amounts of RNA are detected in chimpanzees after infection with an HCV v...