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Ridruejo E, Pereson MJ, Flichman DM, Di Lello FA. Hepatitis C virus treatment failure: Clinical utility for testing resistance-associated substitutions. World J Hepatol 2021; 13:1069-1078. [PMID: 34630875 PMCID: PMC8473504 DOI: 10.4254/wjh.v13.i9.1069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/12/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
The hepatitis C virus has a high mutation capacity that leads to the emergence of resistance-associated substitutions (RAS). However, the consequence of resistance selection during new direct-acting antiviral drug (DAA) treatment is not necessarily the therapeutic failure. In fact, DAA treatment has shown a high rate (> 95%) of sustained virological response even when high baseline RAS prevalence has been reported. In the context of RAS emergence and high rates of sustained viral response, the clinical relevance of variants harboring RAS is still controversial. Therefore, in order to summarize the data available in international guidelines, we have reviewed the clinical utility of testing RAS in the era of new pangenotypic DAA drugs.
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Affiliation(s)
- Ezequiel Ridruejo
- Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno “CEMIC”, Ciudad Autónoma de Buenos Aires C1425AS, Unspecified, Argentina
| | - Matías Javier Pereson
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires 1113, Argentina
| | - Diego M Flichman
- Instituto de Investigaciones Biomédicas en Retrovirus y Síndrome de Inmunodeficiencia Adquirida (INBIRS), Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires 1113, Argentina
| | - Federico Alejandro Di Lello
- Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular (IBaViM), Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires 1113, Argentina
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Frequency of Interferon-Resistance Conferring Substitutions in Amino Acid Positions 70 and 91 of Core Protein of the Russian HCV 1b Isolates Analyzed in the T-Cell Epitopic Context. J Immunol Res 2018; 2018:7685371. [PMID: 29577052 PMCID: PMC5821972 DOI: 10.1155/2018/7685371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022] Open
Abstract
Amino acid substitutions R70Q/H and L91M in HCV subtype 1b core protein can affect the response to interferon and are associated with the development of hepatocellular carcinoma. We found that the rate of R70Q/H in HCV 1b from Russia was 31.2%, similar to that in HCV strains from Asia (34.0%), higher than that in the European (18.0%, p = 0.0010), but lower than that in the US HCV 1b strains (62.8%, p < 0.0001). Substitution L91M was found in 80.4% of the Russian HCV 1b isolates, higher than in Asian isolates (43.8%, p < 0.0001). Thus, a significant proportion of Russian HCV 1b isolates carry the unfavorable R70Q/H and/or L91M substitution. In silico analysis of the epitopic structure of the regions of substitutions revealed that both harbor clusters of T-cell epitopes. Peptides encompassing these regions were predicted to bind to a panel of HLA class I molecules, with substitutions impairing peptide recognition by HLA I molecules of the alleles prevalent in Russia. This indicates that HCV 1b with R70Q/H and L91M substitutions may have evolved as the immune escape variants. Impairment of T-cell recognition may play a part in the negative effect of these substitutions on the response to IFN treatment.
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Pineda JA, Núñez-Torres R, Téllez F, Mancebo M, García F, Merchante N, Pérez-Pérez M, Neukam K, Macías J, Real LM. Hepatitis C virus reinfection after sustained virological response in HIV-infected patients with chronic hepatitis C. J Infect 2015. [PMID: 26212868 DOI: 10.1016/j.jinf.2015.07.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the incidence of hepatitis C virus (HCV) reinfections after therapy-induced clearance in HIV-coinfected patients with prior chronic hepatitis C. METHODS Eighty-four HIV-infected subjects, who had previously achieved sustained virological response (SVR) after being treated of chronic hepatitis C, were analyzed. In all of them, at least yearly HCV RNA determinations were carried out during a median (range) of 34 (12-146) months. RESULTS Seventy-two (86%) subjects had been people who inject drugs (PWID), of whom 11 (15%) continued to use snorted or injected drugs during the follow-up. Four (4.76%) patients showed HCV reinfection (incidence 1.21 [95% confidence interval: 0.3-3.09] cases per 100 person-years). These patients maintained risk factors for HCV infection. In three cases, HCV genotype switched. Phylogenetic analysis of the remaining case suggested reinfection from his sexual partner. CONCLUSION The incidence of HCV reinfection in the overall population of HIV-coinfected patients who achieved SVR after being treated against chronic hepatitis C is low. A low frequency of risk behavior is the main factor accounting for this modest rate of reinfection. The possibility of reinfection should not be considered a reason against treatment of HCV infection with direct acting antivirals in PWID.
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Affiliation(s)
- Juan A Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain.
| | - Rocio Núñez-Torres
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain
| | - Francisco Téllez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltar, Avda. Menéndez Pelayo 103, 11300 La Línea de la Concepción, Cádiz, Spain
| | - María Mancebo
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Federico García
- Servicio de Microbiología, Complejo Hospitalario Universitario de Granada, Centro San Cecilio-PTS, C. Dr. Oloriz, 18012 Granada, Spain
| | - Nicolás Merchante
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Montserrat Pérez-Pérez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital La Línea, AGS Campo de Gibraltar, Avda. Menéndez Pelayo 103, 11300 La Línea de la Concepción, Cádiz, Spain
| | - Karin Neukam
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Juan Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Luis M Real
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Avda. de Bellavista s/n, 41014 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Campus Universitario Virgen del Rocío, Avda. Manuel Siurot s/n, 41013 Sevilla, Spain
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