Read This

This is interesting.

http://www.hivandhepatitis.com/2006roberts/hcv/080906_a.html

[mikesimon]

Yes, it is very interesting. TnHepGuy posted that link earlier today along with 2 more. See his news stories thread below. Mike

[NYgirl]

Wow........considering I know I am infected with two geno's I'm wondering if I could have MORE variants ... that is some seriously SCARY stuff there.  24% have two genotypes? I only know if two other people who do so that seems to be a HUGE difference if it is going unreported or noticed. Might be why some haave a harder time getting SVR.

Thanks. That was depressing ;)

[mkeela]

I was just curious...it looks like a lot of us could be co-infected also after reading all of this stuff and my question is, can they tell if you are co-infected just by the average blood work that they do or are there some special tests they have to perform to find that out? Do they still treat (tx) the same if someone is co-infected? Do they adjust tx differently?

[chellski]

i was thinking the same thing....it seems they only get what they look for, and might have to test further to find out other possibilities.....i remember back in the late 70's i went to give blood and was told i had what showed up as hepatitis non-a and non-b.....so years later we find out this little devil is hep-c....my doctor told me now there is a hepatitis that is non-a non-b and non-c...another strain?  i don't know...it is scary..hopefully my tx knocked every strain on their little butts

[Bill1954]

Further reading on mixed genotype;

From the study

:http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1248436

"...The majority of the HCV genotyping assays in use today were designed to identify only the dominant HCV genotype in a sample and consequently are unable or limited in their ability to identify multiple genotypes in patients infected with more than one strain of HCV. Hu et al. (7) have found that of the HCV infections determined to contain mixed genotypes by DNA sequencing, only 36%, 17%, and 14% were accurately identified as mixtures by type-specific PCR, line probe, and restriction fragment length polymorphism analyses, respectively. Furthermore, DNA sequencing itself was unable to detect 40% of the mixed-genotype infections and could not reliably detect genotypes that were present in mixtures at levels below 25% (7). Consequently, most currently available genotyping methods are unable to assess the prevalence of mixed-genotype infections, which may have a significant impact on the interpretation of clinical studies addressing genotype-specific responses to interferon and interferon combination therapies..."

And, in part:

"...Sensitive and accurate detection of mixed-genotype HCV infections has become an increasingly important requirement of genotyping assays. First, the severity of hepatitis C and patient response to current antiviral therapies seem, at least in part, to be determined by the genotype of the infecting HCV strain (26). Second, mixed-genotype infections may be more common than previously reported given the typical routes of HCV infection and the inadequate sensitivity of most genotyping assays to detect them (20). Among HCV-infected Canadians, mixed genotypes have been found in 8% of HCV-positive blood donors, 14% of patients with chronic hepatitis C, and 17% of thalassemia patients who had received multiple transfusions (7). Thus, the need for HCV genotyping assays able to accurately detect mixed infections is warranted by the appreciable occurrence of such infections and their potential impact on the patient response to antiviral treatment.

Any thoughts/ contempations?

Bill

[Bill1954]

You both pose good questions; I

[FlGuy]

I've got to say that the biology vocabulary hurts my head.  I'm not surprised that there may be more people with multiple genotypes - we have a few here.  But,  they always seem to be in the same geno (ie 1a/1b).  I wonder what makes one more dominant - the VL (more of one than another) or if say the presence of 1 trumps 2 and 3. Dunno.

[Pdilly]

My two ... I am 2a and 2c.   I sure hope that does not mean I won't clear or may have to do extended treatments to clear.

[Tater-ToT]

Ha, Haaa...
Yea the vocabulary hurts my head too... (I was never good at all the technical stuff) I always need it put in laymans terms!

There was some small French Study That actually showed & explained this pretty good based on hemophillia patients... (I'll have to find it) It showed a switch over on mixed genotypes to one or another... but that was mainly between the combo of a (3a & 2)... like 18% (?) maybe did ?

As far as the 1a, 1 b combo group goes ...

WAIT A MINUTE... I Think This is it!
http://www3.interscience.wiley.com/cgi-bin/abstract/46941/ABSTRACT?CRETRY=1&SRETRY=0

Abstract
The distribution and kinetics of hepatitis C virus (HCV) genotypes and the prevalence of mixed infections were studied in a group of 45 French patients with haemophilia A or B or von Willebrand's disease, 21 of them being anti-human immunodeficiency virus (HIV) positive;

genotyping was carried out by three methods based on the core, 5 untranslated region (5 UTR), and the detection of type-specific NS4 antibodies.

Genotyping of the 5UTR revealed genotypes 1a (n = 10), 1b (n = 13), 2a (n = 3), 2b (n = 4), 2NC (n = 3), 3a (n = 10), and two mixed infections (1a + 1b and 3a + 2). Five of 33 patients showed a change from one HCV genotype to another.

The core genotyping assay showed 8 of 45 mixed infections: 6/8 1a + 1b and 2/8 3a + 2.

Sequencing of core polymerase chain reaction (PCR) products showed that mixed infection 1a + 1b could be explained by nonspecific annealing of the 1b primer to type 1a sequence.

By designing new primers whose sequence was more specific to HCV types 1a and 1b, we could confirm 1a + 1b mixed infection in only one of six cases.

Serotyping assay showed for 17 of 21 anti-HIV negative patients a concordance with the 5 UTR genotype; however, only 6 of 19 anti-HIV positive patients showed detectable serological reactivity.

In summary, we have observed a similar HCV genotype distribution between our haemophilic group and the French anti-HCV positive patients.

The study demonstrates the difficulties of assessing with the presently available genotyping and serotyping assays the real prevalence of mixed infections in multiply transfused patients.  

[MissMiss]

I have noticed that those with 2 geno's who don't clear after tx, still have two geno's.  I mean, why doesn't at least one type clear?  Does two geno's raise the "curse" exponentially?  Just something I have always wondered about.  Good reading and thoughts posted too.  Thanks.

miss

[FlGuy]

Kind of reminds me of how Lawrence Welk started all of his conducted music pieces ' a one, and a two'