Skip to main content

Advertisement

SpringerLink
Log in

Temporal dynamics of hepatitis C genotypes in a five-year hospital-based surveillance in Northern Italy

  • Original Article
  • Published:
Archives of Virology Aims and scope Submit manuscript

Abstract

Hepatitis C virus (HCV) genotypes have became important epidemiological markers in the management of HCV-infected subjects and infection treatment. The dynamics of HCV genotypes are changing in Europe. During a five-year (2009-2013) hospital-based surveillance in the area of Parma, Northern Italy, serum/plasma samples from 1,265 HCV RNA-positive subjects were genotyped. Subtypes 1b, 3a, and 1a were predominant (32.6 %, 19.1 %, and 17.8 %, respectively), with a correlation between viral load and gender. Subtypes 1a and 3a were more frequent in adults and males with a significant difference with the over-50 age group and females (P > 0.0001). Subtype 1b, as well as 2a/2c and G2 not-subtypeable (15.7 % and 7.2 %, respectively), were more common in females and in the over-50 age group compared to males (P < 0.0001, P < 0.0001, and P < 0.05, respectively) and the under-50 age group (P < 0.0001). While subtype 1b showed a nearly constant trend, subtype 1a peaked in 2012, when a consistent decrease in G2 was observed. The increasing detection of G4, mainly in adults, and subtypes 1a and 3a suggests their epidemiological relevance in the population. The detection of more than one HCV genotype in the same sample (0.2 %) and different genotypes in distant samples (5.1 %) from the same subject reinforces the opinion that re-infection and super-infection with different genotypes are not negligible events, especially in HIV-infected subjects. The dynamics of HCV genotypes could have significant implications for infection control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

DAA:

direct-acting antiviral

G:

genotype

HCV:

hepatitis C virus

HIV-1:

human immunodeficiency virus type 1

IDU:

intravenous drug user

n-s:

not-subtypeable

References

  1. Bostan N, Mahmood T (2010) An overview about hepatitis C: a devastating virus. Crit Rev Microbiol 36:91–133. doi:10.3109/10408410903357455

    Article  CAS  PubMed  Google Scholar 

  2. Stoll-Keller F, Barth H, Fafi-Kremer S, Zeisel MB, Baumert TF (2009) Development of hepatitis C virus vaccines: challenges and progress. Expert Rev Vaccines 8:333–345. doi:10.1586/14760584.8.3.333

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Zingaretti C, De Francesco R, Abrignani S (2014) Why is it so difficult to develop a hepatitis C virus preventive vaccine? Clin Microbiol Infect 20:103–109

    Article  PubMed  Google Scholar 

  4. Hiroishi K, Eguchi J, Ishii S, Hiraide A, Sakaki M, Doi H, Omori R, Imawari M (2010) Immune response of cytotoxic T lymphocytes and possibility of vaccine development for hepatitis C virus infection. J Biomed Biotechnol 2010:263810. doi:10.1155/2010/263810

    Article  PubMed  PubMed Central  Google Scholar 

  5. Park SJ, Hahn YS (2010) Regulation of host innate immunity by hepatitis C virus: crosstalk between hepatocyte and NK/DC. Rev Infect 1:151–157

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Imran M, Waheed Y, Manzoor S, Bilal M, Ashraf W, Ali M, Ashraf M (2012) Interaction of hepatitis C virus proteins with pattern recognition receptors. Virol J 9:126. doi:10.1186/1743-422X-9-126

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Varchetta S, Mele D, Mantovani S, Oliviero B, Cremonesi E, Ludovisi S, Michelone G, Alessiani M, Rosati R, Montorsi M, Mondelli MU (2012) Impaired intrahepatic natural killer cell cytotoxic function in chronic hepatitis C virus infection. Hepatology 56:841–849. doi:10.1002/hep.25723

    Article  CAS  PubMed  Google Scholar 

  8. Hoofnagle JH (2002) Course and outcome of hepatitis C. Hepatology 36:S21–S29

    Article  PubMed  Google Scholar 

  9. Mühlberger N, Schwarzer R, Lettmeier B, Sroczynski G, Zeuzem S, Siebert U (2009) HCV-related burden of disease in Europe: a systematic assessment of incidence, prevalence, morbidity, and mortality. BMC Public Health 9:34. doi:10.1186/1471-2458-9-34

    Article  PubMed  PubMed Central  Google Scholar 

  10. World Health Organization (WHO), Hepatitis C fact sheet no 164. http://www.who.int/mediacentre/factsheets/fs164/en/index.html. Accessed 10 Sept 2015

  11. Ciccozzi M, Lo Presti A, Ciccaglione AR, Zehender G, Ciotti M (2012) Phylogeny and phylodinamic of hepatitis C in Italy. BMC Infect Dis 12:S5. doi:10.1186/1471-2334-12-S2-S5

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mariano A, Scalia Tomba G, Tosti ME, Spada E, Mele A (2009) Estimating the incidence, prevalence and clinical burden of hepatitis C over time in Italy. Scand J Infect Dis 41:689–699. doi:10.1080/00365540903095358

    Article  PubMed  Google Scholar 

  13. Cozzolongo R, Osella AR, Elba S, Petruzzi J, Buongiorno G, Giannuzzi V, Leone G, Bonfiglio C, Lanzilotta E, Manghisi OG, Leandro G, NUTRIHEP Collaborating Group, Donnaloia R, Fanelli V, Mirizzi F, Parziale L, Crupi G, Detomaso P, Labbate A, Zizzari S, Depalma M, Polignano A, Lopinto D, Daprile G (2009) Epidemiology of HCV infection in the general population: a survey in a southern Italian town. Am J Gastroenterol 104:2740–2746. doi:10.1038/ajg.2009.428

    Article  PubMed  Google Scholar 

  14. Guadagnino V, Stroffolini T, Caroleo B, Menniti Ippolito F, Rapicetta M, Ciccaglione AR, Chionne P, Madonna E, Costantino A, De Sarro G, Focà A, Lentini M, Staltari O, Sersale’s Study Group (2013) Hepatitis C virus infection in an endemic area of Southern Italy 14 years later: evidence for a vanishing infection. Dig Liver Dis 45:403–407. doi:10.1016/j.dld.2012.10.014

    Article  PubMed  Google Scholar 

  15. Medici MC, Valcavi P, Arcangeletti MC, Calderaro A, Martinelli M, De Conto F, Motta F, Pinardi F, Aloisi A, Ferraglia F, Casula F, Dettori G, Chezzi C (2003) Prevalenza di infezione da virus dell’epatite C in un gruppo di soggetti non selezionati per fattori di rischio in un’area geografica del Nord Italia. L’Igiene Mod 120:87–106

    Google Scholar 

  16. Valcavi PP, Natali A, Dieci E, Pilotti E, Chezzi C (1999) Prevalence of hepatitis C virus antibodies in a clinic-based group of Italians from one geographic area. Clin Microbiol Infect 5:125–129

    Article  Google Scholar 

  17. Raffaele A, Valenti M, Iovenitti M, Matani A, Bruno ML, Altobelli E, D’Alessandro A, Barnabei R, Leonardis B, Taglieri G (2001) High prevalence of HCV infection among the general population in a rural area of central Italy. Eur J Epidemiol 17:41–46

    Article  CAS  PubMed  Google Scholar 

  18. Grebely J, Pham ST, Matthews GV, Petoumenos K, Bull RA, Yeung B, Rawlinson W, Kaldor J, Lloyd A, Hellard M, Dore GJ, White PA (2012) Hepatitis C virus reinfection and superinfection among treated and untreated participants with recent infection. Hepatology 55:1058–1069. doi:10.1002/hep.24754

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Blackard JT, Sherman KE (2007) Hepatitis C virus coinfection and superinfection. J Infect Dis 195:519–524

    Article  CAS  PubMed  Google Scholar 

  20. Bukowska-Ośko I, Pawełczyk A, Perlejewski K, Kubisa N, Caraballo Cortés K, Rosińska M, Płoski R, Fic M, Kaźmierczak J, Popiel M, Zabek P, Horban A, Radkowski M, Laskus T (2015) Genetic variability of hepatitis C virus (HCV) 5’ untranslated region in HIV/HCV coinfected patients treated with pegylated interferon and ribavirin. PLoS One 10:e0125604. doi:10.1371/journal.pone.0125604

    Article  PubMed  PubMed Central  Google Scholar 

  21. Eyster ME, Sherman KE, Goedert JJ, Katsoulidou A, Hatzakis A, The Multicenter Hemophilia Cohort Study (1999) Prevalence and changes in hepatitis C virus genotypes among multitransfused persons with hemophilia. J Infect Dis 179:1062–1069

    Article  CAS  PubMed  Google Scholar 

  22. Jarvis LM, Watson HG, McOmish F, Peutherer JF, Ludlam CA, Simmonds P (1994) Frequent reinfection and reactivation of hepatitis C virus genotypes in multitransfused hemophiliacs. J Infect Dis 170:1018–1022

    Article  CAS  PubMed  Google Scholar 

  23. Hayes CN, Chayama K (2015) Emerging treatments for chronic hepatitis C. J Formos Med Assoc 114:204–215. doi:10.1016/j.jfma.2014.09.001

    Article  PubMed  Google Scholar 

  24. Paterson JC, Miller MH, Dillon JF (2014) Update on the treatment of hepatitis C genotypes 2-6. Curr Opin Infect Dis 27:540–544. doi:10.1097/QCO.0000000000000114

    Article  CAS  PubMed  Google Scholar 

  25. Wendt A, Bourlière M (2013) An update on the treatment of genotype-1 chronic hepatitis C infection: lessons from recent clinical trials. Ther Adv Infect Dis 1:191–208. doi:10.1177/2049936113502647

    PubMed  PubMed Central  Google Scholar 

  26. Smith DB, Bukh J, Kuiken C, Muerhoff AS, Rice CM, Stapleton JT, Simmonds P (2014) Expanded classification of hepatitis C virus into 7 genotypes and 67 subtypes: updated criteria and genotype assignment web resource. Hepatology 59:318–327. doi:10.1002/hep.26744

    Article  PubMed  Google Scholar 

  27. Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG, Barnes E (2015) Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 61:77–87. doi:10.1002/hep.27259

    Article  PubMed  Google Scholar 

  28. Liberto MC, Marascio N, Zicca E, Matera G (2012) Epidemiological features and specificities of HCV infection: a hospital-based cohort study in a university medical center of Calabria region. BMC Infect Dis 12:S4. doi:10.1186/1471-2334-12-S2-S4

    Article  PubMed  PubMed Central  Google Scholar 

  29. Marascio N, Matera G, Quirino A, Giancotti A, Barreca GS, Lamberti AG, Caroleo B, Liberto MC, Focà A (2012) Eleven-year distribution pattern of hepatitis C virus in southern Italy. J Pathogol 2012:631095. doi:10.1155/2012/631095

    Google Scholar 

  30. Marascio N, Ciccozzi M, Equestre M, Lo Presti A, Costantino A, Cella E, Bruni R, Liberto MC, Pisani G, Zicca E, Barreca GS, Torti C, Focà A, Ciccaglione AR (2014) Back to the origin of HCV 2c subtype and spreading to the Calabria region (Southern Italy) over the last two centuries: a phylogenetic study. Infect Genet Evol 26:352–358. doi:10.1016/j.meegid.2014.06.006

    Article  PubMed  Google Scholar 

  31. Marascio N, Liberto M, Barreca G, Zicca E, Quirino A, Lamberti A, Bianco G, Matera G, Surace L, Berardelli G (2014) Update on epidemiology of HCV in Italy: focus on the Calabria Region. BMC Infect Dis 14:S2. doi:10.1186/1471-2334-14-S5-S2

    Article  PubMed  PubMed Central  Google Scholar 

  32. Petruzziello A, Coppola N, Diodato AM, Iervolino V, Azzaro R, Di Costanzo G, Di Macchia CA, Di Meo T, Loquercio G, Pasquale G, Cacciapuoti C (2013) Age and gender distribution of hepatitis C virus genotypes in the metropolitan area of Naples. Intervirology 56:206–212. doi:10.1159/000348506

    Article  PubMed  Google Scholar 

  33. Curcio F, Villano G, Masucci S, Plenzik M, Veneruso C, De Rosa G (2011) Epidemiological survey of hepatitis C virus infection in a cohort of patients from a ser.T in naples, Italy. J Addict Med 5:43–49. doi:10.1097/ADM.0b013e3181d131e0

    Article  PubMed  Google Scholar 

  34. Sereno S, Perinelli P, Laghi V (2009) Changes in the prevalence of hepatitis C virus genotype among Italian injection drug users-relation to period of injection started. J Clin Virol 45:354–357. doi:10.1016/j.jcv.2009.04.022

    Article  PubMed  Google Scholar 

  35. Stroffolini T, D’Egidio PF, Aceti A, Filippini P, Puoti M, Leopardi C, Almasio PL, DAVIS Drug Addicted, HCV Prevalence in Italy an Epidemiological, Observational, Cross-Sectional, Multicenter Study Participating Centers (2012) Hepatitis C virus infection among drug addicts in Italy. J Med Virol 84:1608–1612. doi:10.1002/jmv.23370

    Article  CAS  PubMed  Google Scholar 

  36. Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H (2014) Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 61:S45–S57. doi:10.1016/j.jhep.2014.07.027

    Article  PubMed  Google Scholar 

  37. Hadinedoushan H, Salmanroghani H, Amirbaigy MK, Akhondi-Meybodi M (2014) Hepatitis C virus genotypes and association with viral load in Yazd, central province of Iran. Hepat Mon 14:e11705. doi:10.5812/hepatmon.11705

    Article  PubMed  PubMed Central  Google Scholar 

  38. Petruzziello A, Coppola N, Loquercio G, Marigliano S, Giordano M, Azzaro R, Diodato AM, Iervolino V, Di Costanzo G, Di Macchia CA, Di Meo T, Paradiso L, Ferro R, Giuliano P, Russo F, Pasquale G, Cacciapuoti C (2014) Distribution pattern of hepatitis C virus genotypes and correlation with viral load and risk factors in chronic positive patients. Intervirology 57:311–318. doi:10.1159/000363386

    Article  CAS  PubMed  Google Scholar 

  39. Schijman A, Colina R, Mukomolov S, Kalinina O, García L, Broor S, Bhupatiraju AV, Karayiannis P, Khan B, Mogdasy C, Cristina J (2004) Comparison of hepatitis C viral loads in patients with or without coinfection with different genotypes. Clin Diagn Lab Immunol 11:433–435

    PubMed  PubMed Central  Google Scholar 

  40. Ansaldi F, Orsi A, Sticchi L, Buzzone B, Icardi G (2014) Hepatitis C virus in the new era: perspectives in epidemiology, prevention, diagnostics and predictors of response to therapy. World J Gastroenterol 20:9633–9652. doi:10.3748/wjg.v20.i29.9633

    Article  PubMed  PubMed Central  Google Scholar 

  41. La Torre G, Gualano MR, Semyonov L, Nicolotti N, Ricciardi W, Boccia A (2011) Hepatitis C Virus infections trends in Italy, 1996-2006. Hepat Mon 11:895–900. doi:10.5812/kowsar.1735143X.767

    PubMed  PubMed Central  Google Scholar 

  42. Osella AR, Misciagna G, Guerra VM, Chiloiro M, Cuppone R, Cavallini A, Di Leo A, The Association for the Study of Liver Disease in Puglia (2000) Hepatitis C virus (HCV) infection and liver-related mortality: a population-based cohort study in southern Italy. Int J Epidemiol 29:922–927

    Article  CAS  PubMed  Google Scholar 

  43. Pizzillo P, Almasio PL, Ferraro D, Craxì A, Di Stefano R (2009) HCV genotypes in Sicily: is there any evidence of a shift? J Med Virol 81:1040–1046. doi:10.1002/jmv.21498

    Article  PubMed  Google Scholar 

  44. Balogun MA, Vyse AJ, Hesketh LM, Kafatos G, Parry JV, Ramsay ME (2009) Estimating hepatitis C infection acquired in England, 1986–2000. Epidemiol Infect 137:1249–1254. doi:10.1017/S0950268809002143

    Article  CAS  PubMed  Google Scholar 

  45. Vietri J, Prajapati G, El Khoury AC (2013) The burden of hepatitis C in Europe from the patients’ perspective: a survey in 5 countries. BMC Gastroenterol 13:16. doi:10.1186/1471-230X-13-16

    Article  PubMed  PubMed Central  Google Scholar 

  46. Baden R, Rockstroh JK, Buti M (2014) Natural history and management of hepatitis C: does sex play a role? J Infect Dis 209:S81–S85. doi:10.1093/infdis/jiu057

    Article  CAS  PubMed  Google Scholar 

  47. Fabris P, Baldo V, Baldovin T, Bellotto E, Rassu M, Trivello R, Tramarin A, Tositti G, Floreali A (2008) Changing epidemiology of HCV and HBV infections in Northern Italy: a survey in the general population. J Clin Gastroenterol 42:527–532. doi:10.1097/MCG.0b013e318030e3ab

    Article  PubMed  Google Scholar 

  48. Ferraro D, Genovese D, Argentini C, Giordano V, Pizzillo P, Stroffolini T, Craxì A, Rapicetta M, Di Stefano R (2008) Phylogenetic reconstruction of HCV genotype 1b dissemination in a small city centre: the Camporeale model. J Med Virol 80:1723–1731. doi:10.1002/jmv.21276

    Article  CAS  PubMed  Google Scholar 

  49. Bruno S, Crosignani A, Maisonneuve P, Rossi S, Silini E, Mondelli MU (2007) Hepatitis C virus genotype 1b as a major risk factor associated with hepatocellular carcinoma in patients with cirrhosis: a 17-year prospective cohort study. Hepatology 46:1350–1356

    Article  CAS  PubMed  Google Scholar 

  50. Dal Molin G, Ansaldi F, Biagi C, D’Agaro P, Comar M, Crocè L, Tiribelli C, Campello C (2002) Changing molecular epidemiology of hepatitis C virus infection in Northeast Italy. J Med Virol 68:352–356

    Article  PubMed  Google Scholar 

  51. Vitale F, Villafrate MR, Viviano E, Perna AM, Bonura F, Di Benedetto MA, Mazzola G, Colletti P, Prestileo T, Romano N (1998) Distribution of hepatitis C virus genotypes among intravenous drug users. A ten-year study in Palermo, Sicily. New Microbiol 21:335–342

    CAS  PubMed  Google Scholar 

  52. Ciccozzi M, Equestre M, Costantino A, Marascio N, Quirino A, Lo Presti A, Cella E, Bruni R, Liberto MC, Focà A, Pisani G, Zehender G, Ciccaglione AR (2012) Hepatitis C virus genotype 4d in Southern Italy: reconstruction of its origin and spread by a phylodynamic analysis. J Med Virol 84:1613–1619. doi:10.1002/jmv.23384

    Article  CAS  PubMed  Google Scholar 

  53. Njouom R, Caron M, Besson G, Ndong-Atome GR, Makuwa M, Pouillot R, Nkoghé D, Leroy E, Kazanji M (2012) Phylogeography, risk factors and genetic history of hepatitis C virus in Gabon, central Africa. PLoS One 7:e42002. doi:10.1371/journal.pone.0042002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Gededzha MP, Selabe SG, Blackard JT, Kyaw T, Mphahlele MJ (2014) Near full-length genome analysis of HCV genotype 5 strains from South Africa. Infect Genet Evol 21:118–123. doi:10.1016/j.meegid.2013.10.022

    Article  CAS  PubMed  Google Scholar 

  55. Henquell C, Guglielmini J, Verbeeck J, Mahul A, Thibault V, Lebray P, Laperche S, Trimoulet P, Foucher J, Le Guillou-Guillemette H (2011) Evolutionary history of hepatitis C virus genotype 5a in France, a multicenter ANRS study. Infect Genet Evol 11:496–503. doi:10.1016/j.meegid.2010.12.015

    Article  PubMed  Google Scholar 

  56. Verbeeck J, Kwanten L, D’Heygere F, Beguin A, Michiels S, Desombere I, Leroux-Roels G, Lemey P, Nevens F, Van Ranst M (2010) HCV genotype distribution in Flanders and Brussels (Belgium): unravelling the spread of an uncommon HCV genotype 5a cluster. Eur J Clin Microbiol Infect Dis 29:1427–1434. doi:10.1007/s10096-010-1021-0

    Article  CAS  PubMed  Google Scholar 

  57. Pang PS, Planet PJ, Glenn JS (2009) The evolution of the major hepatitis C genotypes correlates with clinical response to interferon therapy. PLoS One 4:e6579. doi:10.1371/journal.pone.0006579

    Article  PubMed  PubMed Central  Google Scholar 

  58. Tuveri R, Rothschild C, Pol S, Reijasse D, Persico T, Gazengel C, Bréchot C, Thiers V (1997) Hepatitis C virus genotypes in French haemophiliacs: kinetics and reappraisal of mixed infections. J Med Virol 51:36–41

    Article  CAS  PubMed  Google Scholar 

  59. Ricchiuti A, Brunati A, Mirabella S, Pierini A, Franchello A, Salizzoni M (2005) Use of hepatitis C virus-positive grafts in liver transplantation: a single-centre experience. Transplant Proc 37:2569–2570

    Article  CAS  PubMed  Google Scholar 

  60. Sullivan DG, Wilson J, Carithers RL Jr, Perkins JD, Gretch DR (1998) Multigene tracking of hepatitis C virus quasispecies after liver transplantation: correlation of genetic diversification in the envelope region with asymptomatic or mild disease patterns. J Virol 72:10036–10043

    CAS  PubMed  PubMed Central  Google Scholar 

  61. Herring BL, Page-Shafer K, Tobler LH, Delwart EL (2004) Frequent hepatitis C virus superinfection in injection drug users. J Infect Dis 190:1396–1403

    Article  PubMed  Google Scholar 

  62. Schröter M, Feucht HH, Zöllner B, Schäfer P, Laufs R (2003) Multiple infections with different HCV genotypes: prevalence and clinical impact. J Clin Virol 27:200–204

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Microbiology and Virology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy

    F. De Conto, M. C. Medici, A. Fazzi, M. C. Arcangeletti, C. Chezzi & A. Calderaro

  2. Unit of Virology, Diagnostic Department, University Hospital of Parma, Parma, Italy

    F. Ferraglia & F. Pinardi

Authors
  1. F. De Conto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. C. Medici
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Ferraglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Pinardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Fazzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. C. Arcangeletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Chezzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Calderaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. De Conto.

Ethics declarations

Funding

This study was funded by grants from the University of Parma (Fondi di Ateneo FIL 2014-FIL2014_DECONTO_MCS).

Conflict of interest

Flora De Conto declares that she has no conflict of interest. Maria Cristina Medici declares that she has no conflict of interest. Francesca Ferraglia declares that she has no conflict of interest. Federica Pinardi declares that she has no conflict of interest. Alessandra Fazzi declares that she has no conflict of interest. Maria Cristina Arcangeletti declares that she has no conflict of interest. Carlo Chezzi declares that he has no conflict of interest. Adriana Calderaro declares that she has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

HCV RNA detection and genotyping were performed according to a medical order; therefore, there was no need to obtain informed consent for the epidemiological analysis of related data.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 47 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Conto, F., Medici, M.C., Ferraglia, F. et al. Temporal dynamics of hepatitis C genotypes in a five-year hospital-based surveillance in Northern Italy. Arch Virol 161, 2727–2737 (2016). https://doi.org/10.1007/s00705-016-2975-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00705-016-2975-8

Keywords

Search

Navigation