CHRONIC HEPATITIS-C VIRUS-INFECTION IN HEMOPHILIC PATIENTS - CLINICAL-SIGNIFICANCE OF VIRAL GENOTYPE

We have undertaken a comprehensive study of hepatitis C virus (HCV) ge notype and its clinical significance in haemophilic patients. 189 HCV RNA positive patients were typed, using the Simmonds classification sc heme, by restriction fragment length polymorphism (RFLP) in an amplifi ed segment of the 5' non-coding region of the HCV genome. Type 1 was f ound in 121 (64.0%), type 2 in 23 (12.2%), type 3 in 36 (19.0%), type 4 in 3 (1.6%), type 5 in 2 (1.1%) and mixed infection in 3 (1.6%). The re were no type 6 infections and one patient (0.5%) could not be typed . Genotype was not associated with diagnosis, age,or with HIV infectio n. Type 1 was associated with higher serum HCV RNA levels, and with a poor response to interferon. Progression to hepatic decompensation has been seen less frequently in those with type 3 compared to type 1 inf ection (p = 0.07). Three out of eleven patients studied over a longer time course showed a change in genotype, the remainder were persistent ly infected with HCV type 1. In conclusion, HCV genotype has clinical relevance in the management of haemophilic patients. Those with type 1 are probably more likely to develop serious liver disease and since t hey respond poorly to interferon-alpha, should be considered for new t reatment strategies aimed at sustained clearance of HCV RNA.