Distribution of Hepatitis C Virus Genotypes, Subgenotypes and Recombinants in Russia

Objective: This chapter aims to evaluate the current epidemiology of HCV infection in Russia and determine the distribution of HCV genotypes and clinically relevant HCV subgenotypes (1a, 1b), as well as recombinant RF1_2k/1b.

Introduction: The hepatitis C virus (HCV) creates both acute and chronic liver infections, which can result in cirrhosis, cancer, and liver failure. HCV is characterized by tremendous genetic diversity and significant variations in the incidence of particular HCV genotypes around the world. Several effective regimens of direct-acting antivirals (DAAs), including pan-genotypic DAAs, can successfully cure HCV infection. Furthermore, genotype-specific HCV medicines are being actively used in national initiatives to eliminate HCV infection around the world. The assessment of HCV genotype prevalence in a given country is required for the successful execution of HCV elimination strategies and for allocating financial resources to the DAAs that are most effective against the particular HCV genotypes prevalent in that country.

Methods: We performed retrospective epidemiological analysis of chronic and acute HCV infections in Russia from 2001 to 2021. A total 10,107 serum samples collected in 2015–2017 from patients with chronic HCV infection living in all federal districts of Russia were screened for HCV genotypes, subgenotypes, and recombinants using PCR and Sanger analysis.

Results: The findings showed that the incidence of acute HCV (AHC) infection in Russia decreased from 16.7 cases per 100,000 people in 2001 to 0.6/100,000 in 2021. During this time, the number of chronic HCV (CHC) infections declined from 29.5 to 16.4 per 100,000 persons. According to the HCV genotyping analysis, HCV genotype 1 predominates in Russia (53.6%), whereas genotypes 3 and 2 were found in 35.4% and 7.8% of patients, respectively. Except for the Far East, where HCV genotype 2 was discovered in barely 1% of the samples, these proportions are nearly equal across Russia. HCV genotypes 1 and 2 are more common in women, while HCV genotype 3 is more common in men. Genotype 3 was most common among 31-40-year-olds (44.9%), while genotype 1 was most common in those over 70 (72.2%). HCV genotype 2 was more common in HCV-infected people above the age of 40. The most HCV RF1_2k/1b was found in the North-West (60%), Southern (41.6%), and Central (31.6%) federal districts, with 14.3% found in the Far Eastern and North Caucasus areas. HCV RF1_2k/1b was not found in the Volga, Ural, or Siberian districts.

Conclusions: This is Russia's first and most comprehensive study of HCV epidemiology and genotype/subgenotype distribution.