Hepatitis C Genotype Prevalence in Monastir Region, Tunisia: Correlation between 5' Untranslated Region (5'UTR), Non-structural 5B (NS5B), and Core Sequences in HCV Subtyping

Overview of the epidemic history of Hepatitis C uncommon subtypes 2i and 4d in Tunisia and in the world

The impressive improvements in qua therapy efficacy alone are not sufficient to substantially reduce the Hepatitis C Virus burden because of the usually very long asymptomatic phase of the infection. In turn, this renders prevention of infection of great importance. The value of learning how the virus has spread in the past is that this can provide clues as to what routes the virus likely spreads through today, which can feedback into prevention policy. In Tunisia, HCV subtypes 2i and 4d are minor circulating subtypes. Here, we applied a Bayesian Markov Chain Monte Carlo method for visualization of spatial and temporal spread of HCV-2i and 4d in Tunisia and some other countries in the world. Our analysis included sequences retrieved from Genbank and isolated from several countries in the world; 21 HCV-NS5B subtype 2i genome sequences obtained during the period 2002-2020 and 206 HCV-NS5B-4d sequences detected between 2000 and 2019. Phylogenetic analysis revealed that two geographical clusters could be identified in HCV-2i tree with two clearly distinguished clusters in HCV-4d Tree. The estimated time for the most recent common ancestor suggested that current HCV-2i strains emerged in 1963 [1930, 1995] and current HCV-4d strains emerged in 1992 [1988, 1996] in Tunisia and other countries from the world investigated in the present study.

Role of hepatitis C virus core antigen assay in hepatitis C care in developing country

Background

The World Health Organization (WHO) aims to achieve global hepatitis C elimination by 2030, defined as diagnosis of 90% of infected individuals and treating 80% of them. Current guidelines for the screening and diagnosis of hepatitis C infection denote using a relatively cheap screen with anti-hepatitis C virus (HCV) antibody immunoassay, followed by the much costlier molecular test for HCV RNA levels using polymerase chain reaction (PCR) assay to confirm active HCV infection. Simplification of the HCV evaluation algorithm to reduce the number of required tests could considerably expand the provision of HCV treatment especially in a developing country. This study investigates the performance of hepatitis C Core Antigen (HCV Ag) test by comparing HCV Ag results versus the results obtained with HCV ribonucleic acid (RNA) PCR which is considered the gold standard for the diagnosis of HCV infection.

Results

Among the 109 anti-HCV positive sera, 96 were positive for both HCV Ag (> 3 fmol/L) and HCV RNA (> 15 IU/mL); 8 were negative for both tests, while the remaining 5 were positive for HCV RNA only. Considering the HCV RNA as gold standard; the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of HCV Ag test were found to be 95.05%, 100%, 100%, and 61.54%, respectively. HCV genotype was performed for 59 patients. The most common HCV genotype was genotype 1 (72.9%). Genotype 2 (15.3%) and genotype 3 (11.9%) were detected in the others samples. A high level of correlation was seen between HCV RNA and HCV Ag (r = 0.958, p < 0.001). The correlation for the samples that were genotyped 1 was significant (r = 0.966, p < 0.001).

Conclusion

In our study, it was found that there was strong correlation between HCV RNA levels and HCV Ag levels. So, it can be used for a one-step HCV antigen test to diagnose active HCV infection.

Hepatitis C in Tunisia from 1991 to 2019: A systematic review

BACKGROUND

Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease and liver cancer related deaths in Tunisia.

AIM

Perform a systematic review on viral hepatitis C in Tunisia between 1991 and 2019.

METHODS

A global search of HCV-specific documentation in Tunisia (1991-2019) in bibliographic data search sites.

RESULTS

Tunisia is a low endemic country for hepatitis C with a prevalence that not exceed 1% in the general population. Several studies have focused on populations at risk of HCV contamination such as hemodialysis and polytransfused patients. The prevalence of hepatitis C is higher in these groups. In relatively small series, a clear predominance of genotype 1 and subtype 1b has been reported in Tunisia with a lower co-circulation of the other genotypes. Several polymorphisms of cytokine and chemokine genes can influence the clearance or persistence of HCV infection. Tunisian studies have focused on the efficacy of conventional dual therapy (pegylated IFN + ribavirin) by analyzing the predictive factors linked to SVR and mutations associated with resistance to viral inhibitors. No publication has discussed the effectiveness of new direct-acting antivirals in Tunisia.

CONCLUSION

This review of the literature provides an update on the status of hepatitis C in Tunisia and reveals a lack of investigations on new direct-acting antivirals.

Focus on hepatitis C virus genotype distribution in Tunisia prior to elimination: a 16-year retrospective study

With the introduction of direct-acting antiviral treatment (DAA), Tunisia has committed to achieving the international goal of eliminating viral hepatitis. Because the specific DAA prescribed depends on viral genotype, viral genotyping remains of great importance. The aim of the present study was to outline the trends in the distribution of HCV genotypes from 2002 to 2017 in the Tunisian general population in order to guide authorities towards the most appropriate therapeutic strategies for preventing HCV infection. A total of 2532 blood samples were collected over a 16-year period and from all regions of Tunisia. Genotyping showed that genotype 1 (subtype 1b) was the most prevalent genotype in the country (n = 2012; 79.5%), followed by genotype 2 (n = 339; 13.3%). Genotypes 3, 4 and 5 were detected in 4.8%, 2.2% and 0.1% of the country's population, respectively. Mixed infections with different HCV genotypes were detected in 0.1% of the population (one case each of genotypes 1b + 4, 1b + 2 and 2 + 4). Interestingly, a significant increase in genotypes 2, 3 and 4 was observed over time (p = 0.03). Sixteen different subtypes were detected over the study period, most of which were subtypes of genotype 2, and some of these subtypes appeared to be new. Patients infected with genotypes 1a, 3 and 4 were significantly younger than those infected with genotypes 1b and 2 (p < 0.01). Furthermore, genotypes 1b and 2 were detected more often in women than men, while genotypes 1a and 3 were detected mostly in men (P < 0.01). Our study confirms a large predominance of genotype1/subtype1b in Tunisia and shows a significant increase in the prevalence of other genotypes over time. These findings reinforce the need for an additional HCV genotype survey to improve the design of treatment strategies in Tunisia.

Hepatitis C virus epidemiology in Central-West Tunisia: a population-based cross-sectional study

This study aimed to assess the seroprevalence, viraemia and genotype distribution of hepatitis C virus (HCV) in a region in Central-West Tunisia. A door-to-door cross-sectional study was conducted on a randomly selected sample. A total of 3178 individuals aged 5 to 74 years and members of 935 families were investigated. Seroprevalence of HCV was assessed using ELISA tests. The viral load was determined by real-time RT-PCR, and HCV genotyping was conducted by amplification and sequencing in the NS5b genomic region. The global prevalence of HCV antibodies was 3.32% (95% confidence interval [CI]: 2.72-4.00). It was significantly higher in women: 4.47% vs. 2.16% in men, p = 0.001. Seroprevalence increased with age, and the highest rates were found in the 50- to 59-year-old age group (12.90%, 95% CI: 9.45-16.86), suggesting a cohort effect with very low contribution of intrafamilial transmission. Genotyping showed a predominance of subtype 1b (84.6%), with cocirculation of subtypes 2c (9.6%), 1a (1.9%), 1d (1.9%) and 2k (1.9%), similar to the previously reported genotype distribution in Tunisia and with no genetic clusters specific to the study region. These results indicate a higher endemicity of HCV infection when compared to the previously reported nationwide surveillance data. This study provides valuable data that can contribute to current strategies to eliminate hepatitis C.

Hepatitis C Genotypes in Libya: Correlation with Patients' Characteristics, Level of Viremia, and Degree of Liver Fibrosis

OBJECTIVES

Our study sought to determine the distribution of hepatitis C virus (HCV)-genotypes among patients attending two tertiary care hospitals in Benghazi and Tripoli, Libya, and correlate this with patient's characteristics, viral load, and degree of fibrosis.

METHODS

We conducted a retrospective study of 286 HCV-RNA positive Libyan patients referred from different health care facilities in east and west Libya for specific HCV treatment. HCV genotyping was carried out by gene amplification. Liver histology was graded by Metavir score according to the stage of fibrosis.

RESULTS

HCV genotypes 1, 2, 3, and 4 were found in 24.1%, 10.8%, 3.4%, and 61.5% of the patients, respectively. Genotype 4 was detected more frequently in patients from east Libya (Benghazi) compared to west Libya (Tripoli) (75.9% vs. 41.6%, p = 0.245). Genotype 1 was more frequent in patients from west Libya compared to east Libya (34.1% vs. 16.8%, p = 0.657). There was a significant correlation between HCV genotype distribution and viral load. Patients with genotype 4 exhibited a higher degree of liver fibrosis (p < 0.001).

CONCLUSIONS

HCV genotype 4 is the predominant genotype in Libya followed by genotype 1. However, as we go from the east to the west of the country, genotype 1 increases. Genotype 4 was associated with higher level of viremia and higher stage of liver fibrosis. It is important to note that both genotypes 1 and 4 are associated with a poor response to pegylated interferon and ribavirin combination therapy. The findings emphasize the need to develop improved strategies in Libya for the successful treatment of HCV infection with novel newly available antiviral drugs.