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SHIFT IN HCV GENOTYPE IN A LIVER TRANSPLANT REFERRAL CENTRE OVER 10 YEARS: THE BRITISH COLUMBIA EXPERIENCE
A Hashim1, M Haque1, M Krajden2, E Yoshida1, U Steinbrecher1, S Erb1 1University of British Columbia Division of Gastroenterology; 2British Columbia Center of Disease Control, Vancouver, British Columbia
AIMS: Cirrhosis from chronic hepatitis C virus (HCV) infection remains by far the most common reason for liver transplantation in North America, accounting now for almost 40% of patients at most centres. HCV patients have been treated with curative therapy in British Columbia since 1990. Current combination of pegylated interferon and ribavirin, available for just over five years, patients with genotype 2 or 3 achieve an SVR rate of 72-80%, greater than those with genotype 1, at 42-46%. We hypothesized that this treatment would have an effect on the genotype of hepatitis C patients referred for liver transplantation over the last ten years, suggesting that there would be a shift to the genotypes less likely to respond to treatment, genotype 1, and away from genotypes easily cured with standard therapy, genotype 2 or 3.
METHODS: The charts of all patients with a diagnosis of hepatitis C who were referred to the British Columbia Liver Transplant Society (BCTS) for liver transplant assessment from January 1, 1999 to July 31, 2009, were reviewed. The genotypes were then confirmed with provincial data collected by British Columbia Centre for Disease Control (BCCDC). Missing genotype data were added to the originally collected data from the BCTS charts. The percentage of genotype 1 patients versus 2 or 3 was determined for each year to assess whether the percentage of easily and successfully treated genotypes declined.
RESULTS: A total of 679 patients were referred for liver transplant assessment between Jan 1, 1999 to July 31, 2009.46% (312) of all patients had genotype results documented on the chart. Only 28% of patients referred from 1999-2004 had genotypes recorded, compared to 68% of those referred from 2005-2009. Of these 312 patients, 73% of patients (227) had genotype 1 whereas 7% (23) had genotype 2 and 18% (57) had genotype 3. Only 3 patients had genotype 4 (1%), and 2 patients had genotype 6 (0.6%). Genotype 2 decreased from 14.0% in 2006, to 7.5% in 2007, to 2.2% in 2008. No genotype 2 patients have yet been referred for transplant assessment in 2009. Genotype 3 increased slightly from 22% in 2004, to 25% in 2007, to 28% in 2008.
CONCLUSIONS: The increased awareness and use of effective hepatitis C therapy over the past five to ten years has likely influenced the current distribution of patients with HCV genotypes 1 and 2 referred for liver transplantation. The distribution of genotypes in this population has shifted toward the harder-to-treat genotype 1 and away from the easily treated genotype 2. Increased immigration from genotype 3-endemic areas may explain the trend for the increased incidence of referrals of genotype 3 patients.