Type-able and Untype-able Genotypes in Hepatitis C Pak Armed Forces Med J 2020; 71 (Suppl-1): S106-12 S106 THE HEPATITIS C UNTYPE-ABLE GENOTYPES, AN EMERGENCE OF QUASI-SPECIES IN HCV INFECTED PATIENTS Qanita Fahim, Irfan Ali Mirza, Ayesha Khalid, Anum Imtiaz, Asad Ahmad* Combined Military Hospital Lahore/National University of Medical Sciences (NUMS) Pakistan, *Avicenna Medical College, Lahore Pakistan ABSTRACT Objective: To determine the frequency of Type-able and untype-able genotypes in hepatitis C infected patients, and to observe their association with gender, age, Alanine Aminotranferease and viral load. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, and Lahore, Pakistan from Sep 2017 to Mar 2018. Methodology: Six hundred forty seven anti HCV antibodies positive serum samples by Enzyme Linked Immuno Sorbant Assay were received from a total of 6791 serum samples. The positive sera were subjected to qualitative PCR and quantitative real time (RT) PCR to determine pre-treatment viral load. Quantitative PCR positive sera with viral load >500IU/ml were further subjected to molecular genotyping by using Ohno et al method. Result: Out of 647 positive serum samples, type-specific PCR fragments were seen in 424 sera, while 13 (3.1%) of serum samples were of untype-able genotype. In all age groups genotype 3a had emerged as a predominant genotype 397 (93.6%), followed by 1b 8 (1.9%), 3b 4 (0.9%), 1a 2 (0.5%), while no sample detected to have 2a, 2b, 5a, 6a and mixed genotypes. The highest prevalence of untype-ables were seen in 61-70 age group. Conclusion: Need of the hour is proper sequencing of untype-able genotypes via upgrading existing methodolo- gies. It will not only help the clinicians in achieving sustained virological response but also help in identifying new genotypes/subtypes. Keywords: Hepatitis C-virus, Genotypes, Untype-able variants. INTRODUCTION Hepatitis C virus (HCV), was discovered in 1989. For long it was thought to be a non-A, non- B virus acquired after blood transfusions. Quickly this discovery led to the development of serolo- gical and molecular methods for HCV detection. Its major value was observed in transfusion set ups where Hep C screening dropped the incident of transfusion acquired infection to nil, and add another test in the panel of investigations for clinical hepatitis 1 . One observes varied differences in the HCV nucleotide sequences. These variations has led to the formulation of genotypic classification of HCV which accommodates variants from all over the world and classify them into six main geno- types. Genotype 7, a rare genotype has also been reported. These genotypes are further divided into subtypes. A 30% sequence divergence was observed in various groups of these genotypes resulting in modifications of their antigenic pro- perties and biological behaviour i.e. (type of trea- tment and response) 2 . A Worldwide distribution has been observed in HCV genotypes like 1a, 2a and 2b, while in South Africa and South East Asia genotype 5a and 6a are common 3 . In USA and countries of Western Europe frequent culprits causing chronic hepatitis are 1a, 1b, 2a, 2b, and 3a genotypes. Mo- reover, their frequencies may vary geographica- lly as in south and Eastern Europe 1b is frequen- tly diagnosed as infection causing genotype while Genotype 1a and 3a are more commonly seen in drug users. In Pakistan most prevalent Genotype is 3 with 3a and 3b subtypes. The 3a and 3b sub- types are circulating with equal frequency among males and females 3-6 . Furthermore, prevalence of Genotype 4 is high in North Africa and Middle East 3 . Mainstay of proper treatment of HCV in- This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Correspondence: Dr Qanita Fahim, Dept of Pathology, Combined Military Hospital Lahore Pakistan Received: 10 Mar 2019; revised received: 06 Aug 2020; accepted: 12 Aug 2020 qanita_fahim@yahoo.com Original Article Open Access