Correlation between mutations in the interferon sensitivity-determining region of NS5A protein and viral load of hepatitis C virus subtypes 1b, 1c, and 2a.

In the present study, we analyzed the possible relationship between interferon (IFN) sensitivity-determining region (ISDR) sequence variation of various hepatitis C virus (HCV) subtypes and serum HCV titers in Indonesian patients without IFN treatment. The viremia titers (mean +/- standard deviation) of HCV subtype 1b (HCV-1b) isolates with low (three or fewer) and high (four or more) numbers of ISDR mutations were 5.4 +/- 0.6 and 4.2 +/- 0.9 log(10) RNA copies/ml, respectively, with the difference between the two groups being statistically significant (P < 0.01). Similarly, the viremia titers of HCV-1c isolates with low and high numbers of ISDR mutations were 5.3 +/- 0.6 and <3.0 +/- 0.0 log(10) RNA copies/ml, respectively, with the difference between the two groups being statistically significant (P < 0.01). Also, the virus titers of HCV-2a isolates with low and high numbers of ISDR mutations were 4.3 +/- 0.7 and 3.5 +/- 0.4 log(10) RNA copies/ml, respectively, with the difference between the two groups being statistically significant (P < 0.01). Thus, our results demonstrated that virus load in Indonesian patients infected with HCV-1b, HCV-1c, or HCV-2a correlated inversely with the number of mutations in the ISDR sequence, implying the possibility that the ISDR sequence plays an important role in determining the levels of HCV viremia.

Viral load in Indonesian patients with chronic liver disease and in blood donors infected with different subtypes of hepatitis C virus.

The viral load of different hepatitis C virus (HCV) subtypes, including the globally distributed HCV-1b and the unique Indonesian subtype HCV-1c, was analyzed using serum samples obtained from Indonesian blood donors and patients with chronic liver disease. The mean viral load of HCV-1c was comparable with that of HCV-1b, suggesting that HCV-1c is as pathogenic as HCV-1b. On the other hand, the mean viral load of HCV-2a was lower than that of HCV-1b or HCV-1c, with this result being consistent with previous observations. Interestingly, some HCV-2a strains were associated with a high viral load that was almost equivalent to that of HCV-1b and HCV-1c. This result implies the possibility that there exists a minor fraction of HCV-2a strains that cause higher levels of viremia compared with the majority of ordinary HCV-2a strains.

Prevalence of GB virus C/Hepatitis G virus infection among various populations in Surabaya, Indonesia, and identification of novel groups of sequence variants.

A molecular epidemiological study was performed to investigate the prevalence of GB virus C/hepatitis G virus (GBV-C/HGV) infection among various populations in Surabaya, Indonesia. The prevalence of GBV-C/HGV RNA, determined by reverse transcription-PCR for a portion of the NS3 region of the viral genome, was 2.7% (4 of 150) among randomly collected blood donor sera, which were all negative for both hepatitis B virus surface antigen and antibodies against hepatitis C virus (HCV). On the other hand, the prevalence among anti-HCV-positive blood donors was 17.8% (13 of 73), with the ratio being significantly higher than that observed with the anti-HCV-negative blood donors (P < 0.001). A high prevalence of GBV-C/HGV infection was also observed among patients with chronic liver disease, such as chronic hepatitis (5.7%), liver cirrhosis (11. 5%), and hepatocellular carcinoma (7.0%), and patients on maintenance hemodialysis (29.0%). No correlation was observed between GBV-C/HGV viremia and serum alanine aminotransferase levels in the populations tested, suggesting the possibility that GBV-C/HGV does not cause apparent liver injury. Phylogenetic analysis of sequences of a portion of the 5' untranslated region and the E1 region of the viral genome identified, in addition to a previously reported then novel group of GBV-C/HGV variants (group 4), another novel group of variants (group 5). This result suggests that GBV-C/HGV can be classified into at least five genetic groups. GBV-C/HGV isolates of group 4 and group 5 were each shown to comprise approximately 40% of the total Indonesian isolates.

Differential distribution of hepatitis C virus subtypes in Asia: comparative study among Thailand, Indonesia, the Philippines and Japan.

Hepatitis C virus (HCV) is currently classified into at least six major genotypes, each of which is further divided into a number of subtypes. It has been reported that prevalence of each subtype varies among different geographical regions of the world and that severity of liver disease and sensitivity to interferon treatment varies with different subtypes. The purpose of this study was to determine and compare the prevalence of each subtype among HCV isolates in different areas in Asia such as southern (Hat Yai) and northern (Chiang Mai) parts of Thailand, Indonesia (Surabaya), the Philippines (Manila) and Japan (Kobe). Sera were obtained from various groups of patients and tested for antibodies against HCV using second and/or third generation ELISA kits. RNA was extracted from anti-HCV-positive sera and reverse-transcribed into cDNA. The cDNA-preparations were subjected to nested PCR to amplify NS5B and 5'-untranslated region (5'UTR) sequences. Amplified fragments were sequenced and subtypes of the isolates were determined based on sequence similarities with reported sequences. In Chiang Mai and Hat Yai, Thailand, HCV-3a, HCV-1a and HCV-1b were common in various populations. HCV type 6 variants were commonly found among blood donors and drug addicts in Chiang Mai, but not in Hat Yai. In Surabaya, Indonesia, HCV-2a was frequently detected in blood donors, but less frequently in patients with chronic liver disease. In blood donors, HCV-1a, HCV-1b and HCV-1d were more strongly associated with elevation of serum aminotransferase levels than HCV-2a. HCV-1a was significantly more common in patients on maintenance hemodialysis than in blood donors or patients with chronic liver disease. HCV-1d was detected exclusively in Indonesia. Another unique subtype HCV-3g was found also in Indonesia, though less frequently than HCV-1d. In the Philippines, a vast majority of the isolates were either HCV-1a or HCV-1b. Thus, HCV subtype prevalence varies among different regions of Asia.

GB virus C/hepatitis G virus (GBV-C/HGV) infection in Chiang Mai, Thailand, and identification of variants on the basis of 5'-untranslated region sequences.

By using reverse transcription and PCR for NS3 and 5'-untranslated regions (5'UTR) of the viral genome, prevalence of GB virus C/hepatitis G virus (GBV-C/HGV) infection in Chiang Mai, Thailand, was studied. High prevalence of GBV-C/HGV infection was observed among intravenous drug users (32%) and hemodialyzed patients (25%). The prevalence was also considerably high among patients with chronic liver disease, such as chronic hepatitis (9%), liver cirrhosis (12%) and hepatocellular carcinoma (10%). On the other hand, the prevalence among healthy blood donors (1%) was significantly lower than that of the above high-risk groups. GBV-C/HGV RNA positivity was significantly higher in individuals with antibodies against hepatitis C virus (24%) than in those without (5%). Phylogenetic analysis of the 5'UTR sequences classified Thai GBV-C/HGV isolates into three groups; (i) a group of isolates that are commonly found in the United States and Europe, (ii) a group of isolates that are commonly found in Asia, and (iii) a group of novel sequence variants.

Differential prevalence of hepatitis C virus subtypes in healthy blood donors, patients on maintenance hemodialysis, and patients with hepatocellular carcinoma in Surabaya, Indonesia.

Determination of the prevalence of liver disease caused by hepatitis C virus (HCV) of various genotypes helps provide an understanding of the virulences of these genotypes. Differences in the prevalences of these genotypes are known to exist in the various geographical regions of the world. Hence, we performed seroepidemiological and molecular epidemiological analyses of HCV in Surabaya, Indonesia. The prevalences of anti-HCV antibodies were 2.3, 76.3 and 64.7% in healthy blood donors, patients on maintenance hemodialysis, and patients with hepatocellular carcinoma (HCC), respectively. HCV-2a was the most common (52%) among the HCV clones obtained from blood donors; this was followed by HCV-1b (15%), HCV-1a (7%), and HCV-1d (7%), a unique Indonesian subtype. The high prevalence of HCV-2a in blood donors was further supported by serotyping analysis that could discriminate HCV type 2 (HCV-2a and -2b) from HCV type 1 (HCV-1a, -1b, and -1d). HCV-1a, -1b, and -1d were strongly associated with elevated serum alanine aminotransferase (ALT) levels in blood donors, suggesting a possibly more pathogenic feature of those subtypes than HCV-2a. In patients on maintenance hemodialysis, HCV-1a and -1b (each 31%) were among the most common subtypes, and in contrast to the case with blood donors, HCV-1a, -1b, and -1d were found in those with normal ALT as well as those with elevated ALT levels. Impaired immune responses of hemodialyzed patients might be responsible for the apparently decreased hepatocytic injury caused by infection with HCV type 1. In patients with HCC, HCV-1b (57%) was the most common; this was followed by HCV-1d (19%) and HCV-2a (5%). Subtype prevalence was not different between HCC patients with advanced liver cirrhosis and those without advanced cirrhosis.

Hepatitis C virus infection-associated markers in sera from blood donors in Surabaya, Indonesia.

Among 2,233 sera obtained from volunteer blood donors, 259 (11.6%) showed elevated alanine aminotransferase (ALT) levels. A second-generation enzyme-linked immunosorbent assay (ELISA) revealed that 23 (8.9%) of the 259 sera were positive for antibodies against hepatitis C virus (HCV), whereas only 9 (1.4%) of 646 sera randomly collected from blood donors with normal ALT levels were positive (P < 0.001). The overall prevalence of anti-HCV antibodies among blood donors was estimated to be 2.3%. HCV RNA was detected in 19 (83%) of the 23 anti-HCV-positive sera with elevated ALT levels, and 8 (89%) of the 9 sera with normal ALT levels. Among the anti-HCV-positive sera, IgM anti-HCV was detected in 5 (22%) of 23 sera with elevated ALT levels and in 2 (22%) of 9 sera with normal ALT levels. All of the IgM anti-HCV-positive sera were positive for HCV RNA, irrespective of ALT levels.

Subtype analysis of hepatitis C virus in Indonesia on the basis of NS5b region sequences.

A recently identified subtype of hepatitis C virus, subtype 1d, was found to be common in Indonesia, being isolated from 4 (20%) of 20 and 11 (34%) of 32 patients with chronic hepatitis and liver cirrhosis, respectively. A new group of sequence variants was also identified, although its prevalence ratio was not as high in the area surveyed.