Genotypic Evolution of Hepatitis C Virus in Chronic Patients: Impact of Treatmentand Non-Compliance
Adil Mehmood, Farheen Aslam, Faizan Zakir Ali, Abdul Ghaffar
Keywords: Chronic Hepatitis, Hepatitis C genotype, Subgenotype mutations, Non-compliance, Drug resistance
ABSTRACT
Introduction: Hepatitis C infection is a leading cause of chronic hepatitis and cirrhosis in Pakistan. While the virus’s genotype generally remains stable, mutations in its subgenotypes can occur randomly or due to environmental factors, significantly affecting treatment response. This study aims to identify mutations in hepatitis C virus (HCV) subgenotypes in patients with chronic hepatitis C during treatment.
Objective: To identify mutations in HCV subgenotypes during treatment and assess the impact of non- compliance on drug resistance and treatment failure
Methods: The study, conducted at Quaid-e-Azam Medical College, Bahawalpur, included 800 patients with chronic hepatitis C. Patients were monitored for adherence, viral load, and mutations via monthly Polymerase Chain Reaction (PCR) and gel electrophoresis. Inclusion criteria included chronic hepatitis C for over six months, excluding those on treatment or with hepatitis B. Data were analyzed using descriptive statistics and chi- square tests.
Results: The study comprised 365 males (45.6%) and 435 females (54.4%), aged 26 to 64 years (mean age 38). Genotype 3a was the most common (62.5%), followed by 1b (18.8%). After 16 weeks of treatment, 75% of patients exhibited undetected subgenotypes, especially non-compliant patients (mainly females), who showed mutations leading to resistance or delayed treatment response. Non-compliance, driven by forgetfulness, illiteracy, poverty, and drug side effects, adversely impacted treatment success.
Conclusion: Genotype 3a was most prevalent, followed by 1b. Non-compliance causes mutations and resistance to treatment. Regular monitoring and adherence are crucial for effective treatment.
Keywords: Chronic Hepatitis, Hepatitis C genotype, Subgenotype mutations, Non-compliance, Drug resistance