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      Changing of HCV Clade Pattern in Iran; the Possible Means for Something Good

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          Abstract

          Dear Editor, Hepatitis C virus (HCV) with around 180 million infected patients worldwide is the leading cause of mortality and morbidity (1). The prevalence of HCV in Iran is about 0.2% (2). Geographically, HCV genotype has specific distribution pattern in the world. However, in many countries it is currently observed that the genotype pattern is going to change. Changing HCV clade pattern is mainly due to world globalization, and traveling to other countries especially to the neighboring ones. There is an interesting and conclusive report on HCV genotype prevalence in Iran published by Jahanbakhsh Sefidi et al. (2013). The study was based on the analysis of HCV genotype prevalence from 2003-2011. The results showed that in 2003, genotype 1a was the most common (47.8 %) and decreased over time (44.9 % in 2011). It was the same for genotype 1b. HCV genotype 3a was shown to be increased over time; in 2003 its prevalence was 30.1% which was increased up to 39.6% in 2011 (3). The results also showed that genotype 3a was more prevalent in young generation demonstrating that this genotype was recently introduced to Iranian population and might be increased in the future. Geographically, Iran is surrounded largely by Pakistan, Afghanistan, Iraq, Turkey, and Kuwait. In Pakistan, more than 10 million individuals are infected with HCV and major prevalent genotype (i.e. about 50% of infections) is genotype 3a. (4). In Iraq, major prevalent HCV genotypes are 1a, 1b, and 3a (5). To our knowledge, there is no report from Afghanistan on HCV genotyping. Genotype 1b is more common in Turkish infected patients (6). In the neighboring countries of Iran, genotype 1a and 1b are common along with 3a. In Iran, the changing pattern from genotype 1 to 3a might be due to traveling between Iran-Pakistan and Iran-Iraq along the borders. Once infected individuals are located in the country, many factors are involved in spreading the new genotype of viral strain. These factors among many others may include host immune system probably not very efficient against new viral strain, intravenous drug abuse, unhealthy dentistry practices, and barbers' unawareness (7). The standard therapy of interferon plus ribavirin against HCV infection exhibits various efficacies on different viral genotypes. Forty six percent of patients infected with genotype 1 achieved sustained virologic response (SVR), while the SVR shown by patients infected with genotype 3 was more than 80 % (8). The changing pattern of HCV clades in Iran showed that HCV 3a might be more prevalent genotype in future. The genotype 3a revealed a very great SVR among interferon-treated patients, compared to genotype 1. Smaller SVR leads to chronicity and hepatocellular carcinoma in large number of infected individuals, while greater SVR will help in saving a lot of money and effort in dealing with infected patients. In Iran, HCV prevalence is very low, and this changing pattern to dominancy of genotype 3a may help to contain viral spread and chronicity.

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          Distribution of Hepatitis C Virus Genotypes in Iranian Chronic Infected Patients

          Background Hepatitis C virus (HCV) has different genotypes throughout the world. Since the determination of which antiviral treatment to be applied is related to HCV genotypes, identification of an individual’s HCV genotypes prior to antiviral therapy is critical. Objectives The purpose of this study was to investigate the distribution of HCV genotypes in a large population of Iranian HCV infected patients. Patients and Methods Eleven thousand, five hundred and sixty one patients with chronic HCV infection which referred to hospitals related to the Tehran University of Medical Sciences and Tehran Hepatitis Center-Clinical Department of Baqiyatallah Research Center for Gastroeneterology and Liver Disease from March 2003 to December 2011 were enrolled. Following extraction of viral RNA of the serum, HCV-RNA was detected using reverse transcriptase-nested polymerase chain reaction (RT-nested PCR) and then HCV genotypes analyzed by restriction fragment length polymorphism (RFLP) assay. Results The mean age of patients was 37.6 ± 14.2 years (range: 1-87). The highest frequency was noted for subtype 1a (44.9%) followed by subtype 3a (39.6%), and 1b (11.3%). Mixed HCV genotypes were also found in 2.5% of the total cases. Subtype 1a was the most frequent genotype in patients over 40 years of age (46.1% versus 42.4%) and subtype 3a was the most frequent in patients under 40 years old (41.5% versus 38.9%). Conclusions This study suggested that the dominant HCV subtype among Iranian patients was 1a followed by subtype 3a.
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            The Prevalence of Hepatitis C Virus in Mashhad, Iran: A Population-Based Study

            Background Hepatitis C virus (HCV) infection is a significant health problem throughout the world. Chronic form of the disease is found in about 75% to 85% of the newly infected individuals. The chronic infection may lead to severe forms including chronic liver disease, cirrhosis and with a higher mortality rate, hepatocellular carcinoma. Since no vaccine has yet been developed against HCV, there is an increasing need to take measures to control the spread of the infection. Therefore, epidemiologic study of the virus is important to manage and monitor the spread of the virus in the community. Objectives The aim of this study was to determine the prevalence of hepatitis C seropositivity in the general population of Mashhad, northeast of Iran. Patients and Methods Three thousand, eight hundred and seventy (3870) individuals living in the city of Mashhad were recruited using cluster sampling method. HCV seropositivity was determined with HCV antibody detection ELISA kit and was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) method. Results In this study the overall seroprevalence of hepatitis C was founded to be 0.2% by using ELISA method. However, the overall Hepatitis C virus infection prevalence was found to be 0.13% with RT-PCR method. Conclusions Our study suggested that the prevalence rate of Hepatitis C virus is below 1% in the general population of Mashhad.
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              Development of Global Consensus Sequence and Analysis of Highly Conserved Domains of the HCV NS5B Prote in

              Background Hepatitis C virus (HCV) is a plus stranded RNA virus which encodes 10 different genes. The HCV NS5B gene encodes a polymerase, which is responsible for the replication of the virus and is a potential target for the development of antiviral agents. HCV has a high mutation rate and is classified into six major genotypes. Objectives The aim of this study was to draw a representing consensus sequence of each HCV genotype, align all six consensus sequences to draw a global consensus sequence and also study the highly conserved residues. Materials and Methods 236 HCV NS5B sequences, belonging to all six genotypes, reported from all over the world were aligned then a representing phylogenetic tree wasdrawn. Results The active site residues D220, D225, D318 and D319, which bind the divalent cations, are highly conserved among all the HCV genotypes. The other catalytic pocket residues, R158, S367, R386, and T390 and R394, which interact with the triphosphate of NTPs, are also highly conserved while T390 is mutated to valine in the genotype 5. The motif B residues G283, T286, T287 and N291, which take part in sugar selection by RdRp, are also highly conserved except for T286 which is mutated to proline in the genotypes 3 and 6. The residues E18, Y191, C274, Y276 and H502, which take part in primer/template interaction, are also high conserved except for H502 which is mutated to serine in genotype 2. High variation in all the six consensus sequences was observed in a 12 amino acid beta hairpin loop, which interacts with the double stranded RNA. Nine different peptides from the highly conserved regions of HCV NS5B protein were drawn which can be used as a peptide vaccine. The HCV NS5B phylogenetic tree shows the clusters of different genotypes and their evolutionary association. Conclusions In spite of a high mutation rate in HCV, the residues which are present in the catalytic pocket, sugar selection and template/primer interaction are highly conserved. These are target sites for the development of antiviral agents or peptide vaccines. The phylogenetic analysis suggests that different HCV genotypes have been evolved from the genotype 1a.
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                Author and article information

                Journal
                Hepat Mon
                Hepat Mon
                10.5812/hepatmon
                Kowsar
                Hepatitis Monthly
                Kowsar
                1735-143X
                1735-3408
                06 January 2014
                January 2014
                : 14
                : 1
                : e11879
                Affiliations
                [1 ]Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan
                Author notes
                [* ]Corresponding Author: Muhammad Sohail Afzal, Atta ur Rahman School of Applied Biosciences, National University of Science and Technology, Islamabad, Pakistan. Tel: +92-3215244808, Fax: +92-5190856102, E-mail: sohail.ncvi@ 123456gmail.com
                Article
                10.5812/hepatmon.11879
                3909638
                869ae45a-d8e7-488e-a7a7-7e03c8346941
                Copyright © 2014, BRCGL.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 April 2013
                : 01 May 2013
                Categories
                Letter

                Infectious disease & Microbiology
                iran,prevalence,genotype,hepatitis c,therapeutics
                Infectious disease & Microbiology
                iran, prevalence, genotype, hepatitis c, therapeutics

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