title: High prevalence of hepatitis C virus subtypes 4c and 4d in Malaga (Spain): phylogenetic and epidemiological analyses.
abstract: Hepatitis C virus (HCV) is a major aetiological agent of chronic hepatitis and it may lead to the development of liver cirrhosis and hepatocellular carcinoma. HCV has been classified into six clades as a result of high genetic variability. A commercial procedure to genotype HCV in 678 patients from Carlos Haya Regional University Hospital, Malaga was used to study the distribution of HCV genotypes in Malaga, southern Spain. A high prevalence of HCV-4 (10.2%) was found. This genotype is found more commonly in Egypt, Central Africa and the Middle East. The distribution of the different subtypes in the 69 patients with HCV-4 was as follows: 4.3% subtype 4e, 7.2% subtype 4a, 11.5% not subtypable, and 76.8% subtype 4c/4d. Of the 53 4c/4d patients, 69% were intravenous drug users and 31% non-intravenous drug users. In order to characterise further the HCV-4c/4d patients, sequences of the non-structural 5B gene (393 bp) were obtained from 36 HCV-4c/4d-infected untreated patients. Phylogenetic tree topologies distinguished clearly the two subtypes: 11 patients were infected by subtype 4c and 25 by 4d. This phylogenetic analysis, reinforced by the epidemiological characteristics, suggests the extension of the HCV-4c and -4d subtypes in the area of Malaga among both intravenous drug users and non-intravenous drug users.
authors.affiliation: Immunology Service, Carlos Haya Regional University Hospital, Malaga, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Fernández-Arcás
authors.forename: Juan
authors.initials: J
authors.lastname: López-Siles
authors.forename: Sofia
authors.initials: S
authors.lastname: Trapero
authors.forename: Angelo
authors.initials: A
authors.lastname: Ferraro
authors.forename: Agueda
authors.initials: A
authors.lastname: Ibáñez
authors.forename: Francisco
authors.initials: F
authors.lastname: Orihuela
authors.forename: Jorge
authors.initials: J
authors.lastname: Maldonado
authors.forename: Antonio
authors.initials: A
authors.lastname: Alonso
mesh_terms: D000328:Adult; D005260:Female; D016174:Hepacivirus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D006526:Hepatitis C / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010802:Phylogeny; D015995:Prevalence; D013030:Spain