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1369
Ann Med Res 2020;27(4):1369-73
Annals of Medical Research
DOI: 10.5455/annalsmedres.2020.03.265
Original Article
Genotype distribution in Hepatitis C patients admitted to
Erzincan Mengücek Gazi Training and Research Hospital
Aysun Yilmaz1, Murat Kara2, Faruk Karakecili3, Bulent Dabanlioglu3, Yusuf Kemal Arslan4
1Erzincan Binali Yildirim University, Health Sciences Institute, Department of Microbiology, Erzincan, Turkey
2Inonu University, Faculty of Medicine, Department of Parasitology, Malatya, Turkey
3Erzincan Binali Yildirim University, Faculty of Medicine, Department of Infectious Diseases and Clinic Microbiology, Erzincan, Turkey
4Erzincan Binali Yildirim University, Faculty of Medicine, Department of Biostatistics, Erzincan, Turkey
Copyright © 2020 by authors and Annals of Medical Research Publishing Inc.
Abstract
Aim: We aimed to determine the genotype distribution in Hepatitis C patients who Parasitology applied to Erzincan Binali Yildirim
University, Mengücek Gazi Training and Research Hospital. Hepatitis C virus, the only member of the genus Hepacivirus of Flaviviridae
family, is responsible for 25%-40% of all liver diseases. Hepatitis C virus causes acute hepatitis C and chronic hepatitis C infections.
Chronic hepatitis C infection causes cirrhosis, liver failure, hepatocellular cancerand liver diseases in terminal periods.
Material and Methods: A total of 77 patients, 41 male and 36 female, who were admitted to Erzincan Binali Yıldırım University,
Mengücek Gazi Training and Research Hospital in the period of January 2013-June 2019, were included in our study. RT-PCR and
DNA sequencing for the 5’UTR region of the HCV genome for HCV genotyping was performed using the ABI Prism 3130 × 1 DNA
Sequencer device.
Results: Sex of a total of 77 patients included in the study; 41 of them are men (53.2%) and 36 are women (46.8%). Average age of the
patients; It was 59.9 ± 16.6 (minimum 20 and maximum 94). HCV G1b (80.5%) in 62 patients, HCV G1a (7.8%) in 6, HCV G3a (3.9%)
in 3, HCV G3 (2.6%) in 2 and HCV G2 (2.6%) was found in 2 patients. HCV G1 (1.3%) was detected in 1, HCV G4 (1.3%) in 1 patient.
Conclusion: The dominant genotype in Hepatitis C patients who applied to Mengücek Gazi Training and Research Hospital was
determined as “HCV Genotype 1b”.
Keywords: Erzincan; genotype; Hepatitis C virus
Received: 25.03.2020 Accepted: 30.03.2020 Available online: 23.04.2020
Corresponding Author: Murat Kara, Inonu University, Faculty of Medicine, Department of Parasitology, Malatya, Turkey,
E-mail: muratkara44@gmail.com
INTRODUCTION
It was noticed in the 1970s that another virus other than
hepatitis A and Hepatitis B viruses were transferred to
human during blood transfusion. This virus was called
as non-A non-B but could not be identied in those
years. Then, in 1989, hepatitis C virus was proved as
one of the factors causing hepatitis by Choo et al., which
was called “non-A and non-B” using recombinant DNA
technology (1). Hepatitis C virus belongs to Hepacivirus
genus of Flaviviridae family. It is spherical, enveloped and
single-stranded, positively directed, containing about
9,600 nucleotides, which mostly non-symptomatic or
show acute or chronic course (1). It is a very serious and
insidious disease that causes liver failure, cirrhosis and
hepatocellular cancer, resulting in death when untreated
(2,3).
The International Committee on taxonomy of viruses
of Flaviviridae study group reported that the number of
Hepatitis C genotypes was 8 (on the basis of the viral
genome sequence), 90 were certain, 44 were uncertain, and
13 were temporary (4). World Health Organization stated
that 399,000 people died in the world due to cirrhosis and
hepatocellular carcinoma caused by the Hepatitis C virus
in 2016 and today approximately 71 million people in the
world suffer from chronic hepatitis C (5).
Transmission of hepatitis C virus; it occurs primarily
through the transfusion of blood and blood products (6,7).
Today, in developed countries, other infectious materials,
especially infected needles used by people using
intravenous agents, are responsible for unsafe therapeutic
injections and blood transfusion in developing countries
(8-10). The most commonly used methods in the diagnosis
of hepatitis C infection were serologically detection of
antibodies (anti-HCV) against the hepatitis C virus with
the enzyme immunoassay and molecular procedures.
This molecular diagnostic method called polymerase
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Ann Med Res 2020;27(4):1369-73
chain reaction (PCR), in which the presence and quantity
of RNA are determined. 7-14 days after the person’s
exposure to the virus, HCV RNA becomes positive while
the person has not yet developed anti-HCV antibodies
(11). Central Asia, South Asia, North Africa and the Middle
East are geographies in the world where the prevalence
of Hepatitis C virus infection is high (12). Genotypes with
the highest prevalence; It is HCV G1 (49.1%) and HCV G3
(17.9%) and then HCV G4 (16.8%), HCV G2 (11%), HCV G5
(2%) and HCV G6 (1.4%) (13). Hepatitis C virus G5, HCV G6
occurs in a small geography and few people are infected
with HCV G7, HCV G8 in the world. In Turkey, the dominant
genotype is HCV G1 with 91.8-93.3%, followed by HCV G3
(3.7-4.9%), HCV G2 (1.5-2.2%), HCV G4 (1.1-2.5%) (14-16).
When the studies conducted in Turkey examined, 80% of
Hepatitis C virus G1 cases consist of HCV G1b cases (14-
16).
MATERIAL and METHODS
Serum samples of patients who previously admitted to
Erzincan Binali Yıldırım University, Mengücek Gazi Training
and Research Hosp ital, Departme nt of Infectious Diseases
and Clinical Microbiology with various complaints from
January, 2013 to June, 2019 were examined. Of these,
those with anti-HCV antibodies were identied and 77
patients with HCV RNA levels were included in this study.
Presence of anti-HCV antibodies in these patients; the
chemiluminescent microparticle enzyme immunoassay
(EIA) was determined using the ABOTT Architect (i2000)
sr device (Abbot Diagnostics, Chicago, IL, USA), which
operates on the principle of the microparticle enzyme
immunoassay (EIA) and qualitatively detects antibodies
formed in the body against the Hepatitis C virus. Then,
AmpliPrep/COBAS TaqMan 48 device (CAP / CTM, Roche,
Diagnostics, Pleasanton, USA) was used in the 3-stage
hybridization study to determine HCV RNA levels. In step
1, reverse transcription of the target was performed. In
step 2, cDNA synthesis was performed. In step 3, million
copies of complementary target DNA from cDNA were
synthesized by PCR amplication. Finally, using the
patient sera to determine the genotypes of the patients,
the device ABI Prism 3130 × 1 DNA Sequencer (Applied
Biosystems, ThermoFisher Scientic, USA.) was used
for RT-PCR and DNA sequencing for the 5’UTR region
of the HCV genome. This device produced capillary
electrophoresis and generated fluorescent signals and
converted them into digital data.
Statistical analysis
The results were presented for categorical variables as
n (%) and for continuous variables as mean ± standard
deviation, median (minimum-maximum) value. Normality
assumption for continuous variables was checked with
the Kolmogorov-Smirnov normality test and hypothesis
tests were selected according to the type of distribution.
For variables with normal distribution, t-test was used
while comparing groups (COPD-ACOS), and Mann-
Whitney U test was used for variables that did not show
normal distribution. For all tests p <0.05 were considered
statistically signicant. Statistical analyses were
performed by using IBM SPSS 20 (IBM Corp. Released
2013. IBM SPSS Statistics for Windows, Version 22.0.
Armonk, NY: IBM Corp.).
RESULTS
The total of 77 patients [41 (53.2%) males and 36 (46.8%)
females] was applied to the hospital infected with hepatitis
C virus (Table 1). There is no signicant difference
between male and female patients. The average age of
male patients was 55.8 ± 18.6 (minimum 20 and maximum
87), the average age of female patients was 64.5 ± 12.7
(minimum 31 and maximum 94) and the average age of all
patients was 59.9 ± 16.6 (minimum 20 and maximum 94),
regardless of gender. According to this; the average age of
women is more than men (p = 0.021) (Table 1).
Table 1. Gender distribution of patients infected with HCV
n %
Gender
Male 41 53.2
Female 36 46.8
Total 77 100.0
In these 77 patients with hepatitis C, HCV G1b in 62 patients
(80.5%), HCV G1a in 6 (7.8%), HCV G3a in 3 (3.9%), HCV G2 in
2 (2.6%), HCV G3 in 2 (2.6%), HCV G1 was detected in 1 (1.3%),
and HCV G4 in 1 patient (1.3%) were identied (Table 2).
Table 2. The genotype distribution of infected people with HCV
Genotype numbers %
HCV G1 1 1.3
HCV G1a 6 7.8
HCV G1b 62 80.5
HCV G2 2 2.6
HCV G3 2 2.6
HCV G3a 3 3.9
HCV G4 1 1.3
Total 77 100.0
The average age of infected people with hepatitis C virus
G1 is 62.7 ± 14.5 and the average age of other genotype
patients is 35.9 ± 15.2 (Figure 1). According to this the
average age of infected people because of hepatitis C
virus G1 is more than the average age of other genotype
patients (p<0.001) (Table 3).
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Ann Med Res 2020;27(4):1369-73
Figure 1. The average age graphic of patients infected with
hepatitis C virus G1 and other genotypes
The HCV RNA level of infected people with hepatitis C virus
is found minimum 5104 IU/ml, maximum 11.430.000 IU/
ml, mean 1.163.143 IU/ml.
DISCUSSION
Today, the presence of Hepatitis C virus, which has 8
genotypes and many subtypes, was proved in 1989 by
Choo et al using recombinant DNA technology (1, 4).
Hepatitis C virus is one of the important health problems
in the world as in our country (17-20). According to World
Health Organization 2015 world report; 2.3 million people
were infected with the Hepatitis C virus (21), 399,000
people died due to cirrhosis in the World in 2016 and
today approximately 71 million people worldwide were
infected with chronic hepatitis C (4). The World Health
Council decided in 2016 to destroy viral hepatitis from
the world until 2030 (22). The World Health Organization
has published “World Health Sector Strategy” to achieve
this goal and is carrying out the necessary studies (21). In
addition, the American Liver Diseases Working Association
Table 3. HCV genotype and / or subtype studies conducted in Turkey
Researchers Year Province Patient
Numbers
G1
(%)
G1a
(%)
G1b
(%)
G2
(%)
G2a
(%)
G2b
(%)
G3
(%)
G3a
(%)
G4
(%)
Mixed
(%)
Others
(%)
Abacioglu et al. (24) 1995 Izmir 89 - 19.1 75.3 3.4 - - - - 2.2 - -
Kucukoztas et al. (25) 2010 Istanbul 115 - 5.2 81.7 1.7 - - 6.1 - 3.5 - -
Buruk et al. (26) 2012
Six Eastern
Black Sea
Provinces
304 92.8 5.3 87.5 1.6 - - 4.9 - 0.7 - -
Us et al. (27) 2014 Eskisehir 203 74.4 2.4 17.7 1.4 - - 1.9 - 1.9 - -
Aktas et al. (17) 2014
Seven
provinces
in Eastern
Anatolia
108 - 8.3 87 - - - - 3.7 1
(G4d) - -
Balin et al. (28) 2016 Elazig 71 87.3 - - 2.8 - - 9.9 - - - -
Karabulut et al. (29) 2016 Istanbul 412 82.5 - - 4.6 - - 10.7 - 2.2 - -
Zeytinli et al. (30) 2017 Istanbul 554 - 23.1 56.5 - - - - 17.3 - 1 -
Oz et al. (31) 2017 Sakarya 235 2.1 5.5 77.4 0.9 - - 8.5 - 3 2.6 -
Our Study 2019 Erzincan 77 1.3 7.8 80.5 2.6 - - 2.6 3.9 1.3 - -
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Ann Med Res 2020;27(4):1369-73
AASLD and the American Infectious Diseases Association
IDSA share posts for the diagnosis, management and
current treatment of Hepatitis C virus infection with the
HCV Guidance website “www.HCV Guidelines.org” (23-
31).
In our study, HCV G1b, which was detected in 62 (80.5%)
of 77 patients, it was 81.7% in the study of Küçüköztaş et
al. (25), 87.5% in the study of Buruk et al. (26) and it was
82.6% in the study of Tüzüner et al. (32).
In our study, HCV G1a was found as 2nd most frequent
with 6 patients (7.8%), it was 23.1% in İstanbul province by
Zeytinli et al. (30), and HCV G3a (3.9%) which was found
in the 3rd place in our study, it was also 17.3% in Zeytinli
et al. (30).
In our study, HCV G2 and HCV G3, which were 2.6%, were
found to be 0.4% and 3.9%, respectively, in the studies
of Ağca et al. (33). The study conducted by Üçbilek et
al. in Çukurova Region with those who use intravenous
substance, HCV G1 and HCV G3 were found to be 29.9%
and 58.6%, respectively and HCV G1 was found to be
11.5% and HCV G1b was not detected (18).
In our study, HCV G4, which was detected in the lowest
prevalence with 1.3% in 1 male patient using intravenous
substance, it was 32% in the study conducted in Kayseri
by Kayman et al. (34) and the highest rate in our country
was in the study of Gökahmetoğlu et al. (35). While it
was determined in prevalence, HCV G4 was not detected
in the study of Üçbilek et al. (18) with those who used
intravenous substances in Çukurova Region. In our study,
HCV G1, which had the lowest prevalence in 1 patients
with a rate of 1.3%, it was detected in the rate of 2.9% in
the study of Tüzüner et al. (32). The genotype and subtype
distribution of the patients infected with the hepatitis C
virus were detected in our study. The ages of HCV G1b
patients were older than the other genotypes patients.
Our study was compatible with the studies of Abacıoğlu
et al. (24), Küçüköztaş et al. (25), Gökahmetoğlu et al. (35),
Kirişçi et al. (36). When our study was compared to the
study results of Abacıoğlu et al. (24), Küçüköztaş et al.
(25), Balın et al. (28), Gökahmetoğlu et al. (35), Sağlıket
al. (37), Borcak et al. (38), Lee et al. (39), It could be seen
that there was accordance with our study. No statistically
signicant correlation was found between HCV RNA
quantitative levels of patients with different genotypes.
CONCLUSION
Nowadays, HCV infection and HCV-related deaths have
been largely prevented by taking wide-ranging preventive
measures, especially the screening of blood and blood
products. However, blood and blood products are still
not screened in more than half of the world countries,
intravenous substance use in both high-income and low-
income countries is the primary route of transmission
of the Hepatitis C virus, with a high incidence of HCV in
the African and Asian continents. For these reasons,
each country needs to pay attention to the distribution of
HCV genotypes and create its own unique diagnosis and
treatment strategies.
With this study, genotype and subtype determination was
performed for the rst time in HCV patients who applied to
Erzincan Mengücek Gazi Training and Research Hospital.
According to the results of the study; In HCV patients who
applied to the Hospital, HCV G1b was detected as the
dominant genotype in 80.5%. Detection rates as follows;
HCV G1a was in the 2nd place, HCV G3a was in the 3rd
place, HCV G2 and HCV G3 at the same proportion was
in the 4th place, and HCV G1 and HCV G4 at the same
proportion was in the 5th place. This genotype distribution
is compatible with our country in general. No statistically
signicant relationship was found between the HCV RNA
quantitative levels of patients in different genotypes.
*** This article was produced from the doctoral thesis study of Aysun
YILMAZ
Competing interests: The authors declare that they have no competing
interest.
Financial Disclosure: There are no nancial supports.
Ethical approval: Erzincan BYU Faculty of Medicine Ethics Committee.
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