Molecular Tracing of Hepatitis C Virus Genotype 1 Isolates in Iran: A NS5B Phylogenetic Analysis with Systematic Review

Sofosbuvir Resistance-associated Substitutions in the Palm Domain of HCV-NS5B RNA Dependent RNA Polymerase; Study of two Sofosbuvir non-responders

OBJECTIVE

In current study we performed sequencing of palm domain of HCV-NS5B gene, its ancestral analysis along with amino acids substitution analysis. These analysis were done to find the molecular basis of the viral resistance against Sofosbuvir drug.

METHODS

Blood samples from individuals with chronic Hepatitis C infection that were resistant to Sofosbuvir were collected. The samples were processed for their molecular characterization that included RNA extraction, Complementary DNA (cDNA) synthesize, nested PCR, gel elution, Sequencing, ancestral and 3D structure analysis.

RESULTS

Evolutionary analysis revealed that current study sequences (QAU-01, QAU-02) clustered with a previously studied sequence, KY971494.1. Moreover, we reports multiple novel amino acid substitutions in the palm domain of NS5B gene such as Ile116Val, Asn117Gly, Glu246Ala, Val252Ala, Glu258Gln, Cys262Leu, Ser269Arg, Ala272Thr, Ile293Leu, Lys304Arg, Asn307Gly, Ala338Val and Arg345Gly in our query sequence (QAU-01). At 246 and 269 position in (QAU-02), no substitution was observed.

CONCLUSIONS

We have noticed that the current sequences are relatively emerging and could have been originated from aforementioned sequence recently. Based on the current results, we suggests that these substitutions could be associated with structural or functional impairment of protein and could also be may be considered as resistance associated substitutions (RAS) to Sofosbuvir drug.

Real-life efficacy of generic sofosbuvir/ledipasvir for treatment of Iranian patients with chronic hepatitis C: A cohort study

Background

Treatment of hepatitis C virus (HCV) infection with recently introduced direct-acting antiviral agents (DAA) is effective and safe, however there is little known regarding safety and efficacy of generic DAAs in the real-life clinical setting. This study aimed to evaluate the efficacy and safety of generic sofosbuvir/ledipasvir (SOF/LDV) in a real-life clinical experience.

Methods

In this prospective cohort study, patients with chronic HCV infection who referred to Middle East Liver Diseases (MELD) Center were included. Based on the patients' condition, they were treated with SOF/LDV fixed-dose combination with or without ribavirin (RBV) for 12 or 24 weeks.

Results

A total of 30 (M/F: 19/11) patients with chronic HCV genotype 1 infection with a mean age of 49.8 years were treated with generic SOF/LDV with (9 patients) or without (11 patients) RBV for 12 (27 patients) or 24 (3 patients) weeks. Ten (33.3%) had cirrhosis and 13 (43.3%) with a previous history of treatment with interferon (IFN)-based regimens. Among the 30 patients, 26 (86.7%, 95% CI=70.3%-94.7%) achieved a rapid virologic response, 30 (100%, 95% CI=88.7%-100%) achieved the end of treatment response and 30 (100%, 95% CI=88.7%-100%) achieved a sustained virologic response. No severe treatment adverse event was observed however, 6 (20%) patients experienced mild to moderate adverse events.

Conclusion

The treatment of HCV genotype 1 infection with generic SOF/LDV found to be safe and effective even in patients with cirrhosis and previous history of treatment with IFN-based treatments.

Peg-interferon Plus Ribavirin Combination Therapy in HCV Mono-infected and HCV/HIV Co-infected Patients in Iran

Background: Hepatitis C virus (HCV) infection is a cause of major liver complications, particularly in patients infected with human immunodeficiency virus (HIV). This study aimed to evaluate the efficacy of pegylated interferon (Peg-IFN) and a fixed dose of ribavirin treatment among Iranian HCV mono-infected and HCV/HIV-co-infected patients.

Methods: A total of 214 HCV mono-infected and HCV/HIV co-infected patients attending Liver Disease Center in Tehran were assigned to receive treatment with Peg-IFN-α2a or -α2b plus ribavirin for 24-48 weeks. Sustained virologic response (SVR) was used as the primary efficacy endpoint of Peg-IFN and ribavirin therapy.

Results: Treatment with Peg-IFN and ribavirin has been associated with a considerably higher rate of SVR (24 weeks for HCV genotype 3 and 48 weeks for HCV/HIV co-infected and HCV genotype 1 patients). Overall, the clearance of HCV-RNA at the end of therapy occurred in 48.6% of patients. Adverse events leading to treatment discontinuation were seen in 14% of patients.

Conclusion: This retrospective study revealed a relatively well-tolerated response in both HCV mono-infected and HCV/HIV coinfected patients during treatment with Peg-IFN and ribavirin. However, the recent revolutionized interferon-free therapies for chronic HCV infection should be taken into account for achieving a greater response and minimal adverse events.

Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective?

Introduction

Patients with drug addiction have high risk for hepatitis C virus (HCV). Effective treatment response is essential to optimize treatment for drug abusers infected by hepatitis C virus.

Aim

The aim of this present study was to show that hepatitis C treatment in patients with drug addiction is effective like patients without drug addiction.

Material and Methods

Total amount of 57 patients with hepatitis C (25 drug abuser and 32 non-drug abuser) that referred to Shahid Motahari clinic of Shiraz were selected. All patients infected with HCV treated by combination regimens of ribavirin, sofosbuvir and interferon. Patients received sofosbuvir (400mg once a day) in combination with peg-IFN-alpha (92a180m/w›92b1/5m/kg/w) and RBV (under 75 kg 1000mg, over 75 kg 12000kg) for 12 weeks. The Kolmogorov-Smirnov test was used for testing normality. Associations between variables were analyzed using a Chi-square, Fisher exact, T student and Mann-Whitney U test.

Results

Out of 25 HCV patients (43.9%) were drug addicts and 32 patients (56.1%) were non-drug addicts. Insomnia (61.4%), fatigue (63.1%) and debility (49.1%) were more common adverse effects of therapy in drug abusers and non-drug abusers. Alanine transaminase (ALT) and HCV RNA was normal in the end of therapy (EOT). White blood cell (WBC) count decreased in during two-week after starting of the treatment and then increased to normal levels at the end of treatment. Reduction of WBC count was considerable in during two-week. Hematologic result was not considerable. Reduction of hemoglobin was <10 g/dL in 9.37% of non-injecting drug addicts and <8.5 g/dL in 6.25% of injecting drug addicts. The results of this study did not demonstrated a significant relationship about sustained virologic response (SVR) between the drug abusers and non-drug abusers (P = 0.99).

Conclusions

In conclusion, patients with drug addiction can receive hepatitis C treatment on the history of their past or current drug use status. Combination therapy with sofosbuvir plus peginterferon and ribavirin can lead to high treatment response in HCV patients were drug abuser. In addition, this treatment combination was with low discontinuation rates and low adverse effects. Effective intervention in HCV patients with drug addiction to reduce injection- related risk.