ABSTRACT
BACKGROUND: Hepatitis C virus (HCV) evolution is thought to proceed by mutations within the six major genotypes. Studies of HCV recombinant genotypes in different parts of the world have recently been initiated. Only a few cases of recombination have been identified worldwide, predominantly in Eastern Europe and Asia. In 2011 we detected the recombinant form (RF) of a HCV genotype RF_2k/1b in Georgia. Therefore, we reviewed HCV genotyping data of 491 patients with chronic hepatitis C virus infections of our center in Tbilisi over a period of two years. METHODS: Initially all genotyping analyses were performed with the VERSANT HCV genotype assay (Siemens, LiPA). In a second analysis, parts of the core and the NS5B region were sequenced for all HCV genotypes 2a/2c. RESULTS: Approximately 2/3 of genotype 2 cases were identified as the recombinant form HCV-RF 2k/1b. Overall, this type represented 19% of all HCV patients who underwent genotyping. CONCLUSIONS: We can conclude that almost 20% of HCV infected Georgian patients are infected with HCVRF_2k/ 1b.
Subject(s)
Genotype , Hepacivirus/genetics , Hepatitis C, Chronic/virology , Reassortant Viruses/genetics , Adult , Aged , Female , Georgia (Republic) , Humans , Male , Middle Aged , Retrospective Studies , Young AdultABSTRACT
UNLABELLED: ⦠BACKGROUND: Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ⦠METHODS: The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ⦠RESULT: The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ⦠CONCLUSIONS: The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency.
