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Case Reports
. 2022 Sep 15;19(18):11655.
doi: 10.3390/ijerph191811655.

DAA Treatment Failure in a HIV/HBV/HCV Co-Infected Patient Carrying a Chimeric HCV Genotype 4/1b

Maria Antonia De Francesco  1 , Franco Gargiulo  1 , Serena Zaltron  2 , Angiola Spinetti  2 , Francesco Castelli  2 , Arnaldo Caruso  1
Affiliations
Case Reports

DAA Treatment Failure in a HIV/HBV/HCV Co-Infected Patient Carrying a Chimeric HCV Genotype 4/1b

Maria Antonia De Francesco et al. Int J Environ Res Public Health. .

Abstract

Approved direct antiviral agent (DAA) combinations are associated with high rates of sustained virological response (SVR) and the absence of a detectable hepatitis C viral load 12-24 weeks after treatment discontinuation. However, a low percentage of individuals fail DAA therapy. Here, we report the case of a HIV/HBV/HCV co-infected patient who failed to respond to DAA pangenotypic combination therapy. The sequencing of NS5a, NS5b, NS3 and core regions evidenced a recombinant intergenotypic strain 4/1b with a recombination crossover point located inside the NS3 region. The identification of this natural recombinant virus underlines the concept that HCV recombination, even if it occurs rarely, may play a key role in the virus fitness and evolution.

Keywords: DAA; SVR; genotype; recombination.

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Conflict of interest statement

The authors report no potential conflict of interest to disclose.

Figures

Figure 1
Figure 1
Phylogenetic tree analysis of a hepatitis C virus strain (BS172021) isolated from our patient compared with reference strains. The neighbor-joining tree was based on the core (A), NS3 (B), NS5A (C) and NS5B (D) sequences and the genetic distance was estimated using the Kimura 2 parameters model. The sequences identified in this study are marked in yellow. Reference sequences are labelled with their subtypes and accession numbers.
Figure 2
Figure 2
Bootscan plot of the NS3 region of our strain (BS172021) generated using the SimPlot software. It displays the bootstrap support for the clustering of the BS172021 NS3 region with 3 genotype reference genomes in 100-nt-sliding windows, 10 nt increments, and the Kimura 2-parameter model method with a transition-transversion (Ts/Tv) ratio of 2.0 across the viral genome. The curves are colored in yellow, blue, pink, and grey according to the genotype key on the right.
See this image and copyright information in PMC

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