Hep C Genotype Switch

[maureen654]

has anyone ever heard of going from genotype 1a to genotype 4? i was diagnosed with hep c(was called non a non b hep back then) in 1976 in 2000 i had a geno typing done and it was 1a again in 2005 i had a geno typing done to start treatment and was again 1a, in august of this year they again did a genotyping and this time it was type 4 i had them retest 2 is this possible?
 

[Tim Horn]

Hi Maureen:

What you're probably dealing with here is more than one HCV infection, or a "mixed-genotype" infection. In other words, you were likely infected with both HCV genotype 1a and HCV genotype 4. People with multiple infection exposures -- particularly those who have used clotting factors, received more than one blood transfusion or have a long-ish history of injection drug uses -- can be infected with different varieties of the virus around the same time or, sometimes, become infected with one form of the virus then another months or years later.

It may simply be that the last time you had your virus checked, the genotype 4 strain was dominant strain in your blood. In other words, genotype 1a may still be present, but simply didn't get picked up by the test used to evaluate your last specimen. It's also possible that your treatment back in '05 was very effective against your genotype 1b infection, but didn't quite do the job when it came to your genotype 4 infection.

This may complicate treatment somewhat, given that we know that a combination of an HCV protease inhibitor, pegylated inteferon and ribavirin work reasonably well against genotype 1a and 1b, but really don't know how well this triple-drug combo works against genotype 4 infection (though there is some evidence that all three treatments are active against it).

Are you thinking about re-treatment?

Tim Horn

[maureen654]

i was supposed to start it when it first came out they never found out how i got it to begin with i was 11 years old at the time never had a blood transfusion never did any drugs or risky behavior. i cleared with the first treatment but after 8 weeks it showed again as 1a im totally lost lol