Analysis of hepatitis C virus genotype 3 resistance to direct acting antivirals

Treatment of hepatitis C virus (HCV) with direct acting antivirals (DAAs), results in a sustained virological response (SVR) that varies according to the viral genotype. Genotype 3 is the second most prevalent in Brazil and presented the lowest response among all genotypes, this was associated with the occurrence of resistance substitutions in the viral genome. The aim of this study was to analyze genotype 3 viruses circulating in Brazilian patients who do not respond to treatment with Daclatasvir to investigate the presence of novel substitutions within NS5A, and to investigate the role of these substitutions in resistance to different NS5A inhibitors in vitro. A total of 60 patients have been analyzed, including 4 relapsers. Samples collected before (all patients) and after treatment (relapsing patients) were analysed by RNA extraction, cDNA synthesis, amplification by Nested-PCR and direct Sanger sequencing. Many previously undefined substitutions were indeed observed. These included S98G which, although detected in 15 % of pre-treatment samples, substitution appeared in 75 % of post-treatment samples from the non-responding patients and only in 10.7 % of responding individuals. For post-treatment samples in relapsing patients, this substitution had a prevalence of 50 %. Due to the high prevalence, this substitution showed potential to be associated with therapy failure. The phenotypes of this substitution and others identified in the study are being evaluated in the context of a genotype 3a subgenomic replicon and infectious virus to determine their effect on DAA resistance and/or potential fitness cost.