title: Multiple infections with different HCV genotypes: prevalence and clinical impact.
abstract: BACKGROUND
  In a HCV genotype 3a-infected patient, viremia with a different genotype (1b) was detected after 16 weeks of ineffective therapy. Serological typing revealed that this genotype had already been present prior to therapy.
  
  
  OBJECTIVE
  To investigate the epidemiology of multiple HCV infections and the therapeutical consequences for patients superinfected with a new HCV strain.
  
  
  METHODS
  Sera of 600 patients were screened for infection with multiple genotypes by using sequencing and a serological assay in parallel.
  
  
  RESULTS
  Infection with two different HCV types was detected in 13 patients. The prevailing strain was genotyped by sequencing. From two of these patients additional sera were available which had been drawn up to 24 and 28 months prior to the current sample, respectively. Those early samples showed viremia with a HCV subtype that could not be detected by PCR afterwards. Only antibodies to the initial strain were detectable in the later samples.
  
  
  CONCLUSIONS
  In patients serially infected by different HCV strains, one strain will prevail as the viremic virus. Under antiviral therapy, the displaced strain may become viremic again and may influence the outcome of therapy. Detection of inferior strains by serological assays before antiviral therapy may be important for choosing the adequate regimen.
authors.affiliation: Institut für Medizinische Mikrobiologie und Immunologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. mschroet@uke.uni-hamburg.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Schröter
authors.forename: Heinz-Hubert
authors.initials: HH
authors.lastname: Feucht
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zöllner
authors.forename: Peter
authors.initials: P
authors.lastname: Schäfer
authors.forename: Rainer
authors.initials: R
authors.lastname: Laufs
mesh_terms: D003430:Cross-Sectional Studies; D005858:Germany / Q000453:epidemiology; D016174:Hepacivirus / Q000145:classification* / Q000235:genetics; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D017720:Molecular Epidemiology; D012367:RNA, Viral / Q000145:classification / Q000235:genetics; D012307:Risk Factors; D017423:Sequence Analysis, RNA; D012703:Serotyping
chemical_list: D018937:Hepatitis C Antibodies; D012367:RNA, Viral