Distribution and clinical correlates of viral and host genotypes in Chinese patients with chronic hepatitis C virus infection

Abstract

Background and aim: Chronic hepatitis C virus (HCV) infection is relatively frequent in China. This study investigated the clinical, demographic, and viral and host genetic characteristics that may influence disease manifestations and clinical management.

Methods: In this cross-sectional observational study, treatment-naïve Han ethnic adults with recently confirmed chronic HCV infection were enrolled at 28 hospitals across China. HCV genotype and host interleukin 28B (IL28B) genotypes were determined and compared with patient demographic parameters and medical status.

Results: Among the 997 HCV-positive patients analyzed, 56.8% were infected with HCV genotype 1b, followed in prevalence by genotypes 2, 3, and 6, with substantial regional variation. Overall, 84.1% of patients were IL28B genotype CC (rs12979860), with little regional variation. Cirrhosis was reported in 10.1% of patients and was significantly associated with hepatitis B virus coinfection, low HCV viral load, low serum alanine aminotransferase, high serum aspartate aminotransferase, diabetes, and high pickled food consumption. Medical procedures were common transmission risk factors; however, lifestyle-associated risk factors, including intravenous drug abuse and tattoos or piercings, were more common in patients with HCV genotype 3 or 6.

Conclusions: Most HCV-infected Han Chinese patients were IL28B genotype CC (rs12979860). HCV genotypes varied by geographic region, and disease characteristics differed according to HCV genotype. Relatively frequent detection of advanced liver disease may reflect limitations on access to antiviral therapy, and suggests that greater awareness of factors that influence HCV-associated disease may help avoid clinical complications and improve patient outcomes.

Keywords: China; HPV; IL28B; cirrhosis; epidemiology; natural history.

Figure 1

Distribution of enrolled patients by province and region. Chinese regions as defined in this study are color-coded; the number of patients enrolled in each province is shown with regional totals and proportions of the total enrolled population.

Figure 2

Distribution of hepatitis C virus (HCV) and IL28B genotypes by region. Data indicate percentages of patients with the indicated (a) HCV or (b) IL28B genotype in each region, and in the total study population. HCV genotype: , 1b; , 2b; , 3b; , 6c; , 1a; , 2a or 2c; , 3a; , 6a or 6b; , multiple genotypes; , subtype unidentifiable. IL28B genotype rs12979860: , CC; , CT; , TT.

Figure 3

hepatitis C virus (HCV) transmission risk factors by HCV genotype. The proportions of patients with self-reported transmission risk factors are shown by HCV genotype. Some patients reported multiple factors. , other; , surgery, organ transplant; , interventional exams and treatments; , dialysis; , tattoos, piercings; , long-term HCV exposure; , dental treatment; , IV infusion; , IV drug abuse; , blood transfusion; , sex.

Figure 4

Correlates of cirrhosis. Odds ratios and 95% confidence intervals are shown for parameters entered into the multivariate model. *High alcohol consumption was defined as ≥ 40 g/day (men) or ≥ 20 g/day (women). †Tea and pickled food consumption defined as high (at least twice daily), average (twice weekly to once daily), or low (at most once weekly).