Hepatitis C Virus Subtype and Evolution Characteristic Among Drug Users,Men Who Have Sex With Men,and the General Population in Beijing,China

The aim of this study was to characterize the current molecular epidemiology of hepatitis C virus (HCV) infection and evaluate the evolutionary patterns of HCV subtypes in Beijing, China, among different subpopulations.The whole blood samples and behavioral data were collected from a total of 10,354 subjects, including drug users (DUs), men who have sex with men (MSM), and the general population, in Beijing from 2010 to 2011. Samples were tested for HCV infection using both enzyme-linked immunosorbent assay (ELISA) and real-time PCR. All viremic subjects were then sequenced by nested PCR over core/E1 and NS5B regions. Phylogenetic and phylogeographic analysis was performed by BEAST software.In total, 217 subjects (2.1%) were tested positive for HCV by antibody or vRNA-based testing. HCV prevalence rates for DUs, MSM, and the general population were 26.2%, 0.54%, and 0.37%, respectively. The 156 HCV RNA-positive samples were sequenced. Nine HCV genotypes, including 1a, 1b, 2a, 3a, 3b, 6a, 6n, 6u and 6v, were detected. The most prevalent subtypes were 3b (36.09%), 1b (32.54%), and 3a (16.57%). Bayesian evolutionary analysis estimated that the time of introduction of subtype 1b into Beijing was 2004 (95% CI: 1997.7, 2007.7), with subtypes 3a and 3b being introduced later in 2006. Evolutionary analyses further suggested that subtype 1b from Beijing and Shanghai were closely related, whereas subtype 3a sequences were more similar with sequences from Yunnan, Guangzhou, Hong Kong, and Jiangsu. Subtype 3b sequences were closely related to those from Yunnan, Guangdong, and Hong Kong.Thus, the current HCV epidemic in Beijing is complex, heavily affecting DUs, and involving multiple genotypes that likely spread from different regions in China with its large migrant population.     

The distribution of hepatitis C virus genotypes in Turkish patients

Summary. The distribution of hepatitis C virus (HCV) genotypes was investigated in 89 HCV-infected Turkish patients. Blood samples were collected from haemodialysis patients ( n = 45), chronic liver disease (CLD) patients ( n = 38), acute non-A, non-B (NANB) hepatitis patients ( n = 2) and blood donors ( n = 4). HCV RNA sequences were amplified in the 5" non-coding region and were typed by restriction fragment length polymorphism analysis. The predominant genotype was 1b (75.3%), followed by 1a (19.1%), 2 (3.4%) and 4 (2.2%). While there was no significant difference in the distribution of HCV genotypes with respect to age, sex, transfusion history, alanine aminotransferase levels or liver histology (in the CLD group), type 1a-infected patients were younger than type 1b-infected patients ( P < 0.05) in the haemodialysis group. Serological reactivity to recombinant HCV proteins was assessed in 58 samples using the Chiron RIBA-2 assay. The reactivity of samples from patients infected with type 1b with 5–1–1 and c100 antigens was significantly lower ( P < 0.05) than the reactivity of samples from those infected with type 1a. These results, together with the results of two previous studies, indicate that HCV genotypes 1, 2, 3 and 4 are prevalent in different frequencies in the Turkish population. Determination of the genotype distribution of HCV in a geographical area may provide important clues for studying the epidemiology, transmission and pathogenesis of HCV-related diseases and may also aid in improving serological assays to detect HCV infection.     

Genetic diversity of HCV among various high risk populations (IDAs,thalassemia, hemophilia,HD patients) in Iran

ObjectiveTo determine the patterns of distribution of HCV genotypes among high risk population in north of Iran.MethodsA cross-sectional study was conducted on 135 HCV RNA-positive high risk individuals including thalassemia, hemophilia, patients under hemodialysis and intravenous drug addicts. HCV genotypes were determined based on amplification with type-specific primers methods.ResultsAmong the 187 anti-HCV positive samples, only 135 (72.2%) gave HCV-RNA positvity. Over all, the most identified HCV type was genotype 3a (51.1%) followed by 1a (27.4%), 1b (8.2%). Sixteen (11.9%) out of 135 HCV RNA-positive participants have infected with more than one genotype or subtypes as follow; 1a/1b in 11 (8.2%), 2/3a in 3 (2.2%), and 1a/1b/3a in 2 (1.5%). Stratification of participants revealed that HCV subtype 3a was more prominent in thalassemia, hemophilia and HD patients but 1a and 1b were frequent in intravenous drug addicts.ConclusionsThis study is the first report on HCV genotypes among Iranian subjects with different exposure categories resided in Mazandaran, where genotype 3a was found to be the most frequent genotype in thalassemia, hemophilia, and hemodialysis patients but not in IDAs. Since the addiction age is decreasing in Iran and a lot of addicts are IDAs, it might change the subtype pattern of HCV in general population.     

中国兰州地区丙型肝炎病毒感染的基因型分布特征

目的了解中国兰州地区丙型肝炎病毒（HCV）感染基因型分布特点。方法筛选41例来自兰州的HCVRNA阳性患者血清样品,扩增HCV5′非编码区（5’NCR）,得到257bp的聚合酶链反应（PCR）产物,并对这些产物进行测序。然后将所得序列与GenBank参考序列比对,并作同源性分析和进化分析。结果 41例样品中共检出1b型感染25例（61.0%）,1c型感染8例（19.5%）,2a型4例（9.8%）,1a型3例（7.3%）,3b型感染1例（2.4%）。结论兰州地区的基因型分布以1b型为主,并首次在中国检出1c型感染,且感染率仅低于1b型;此外还检出2a、1a和3b;未检出4、5和6型等基因型。     

Prevalence of hepatitis C infection among intravenous drug users in Shanghai

AIM:To characterize the prevalence of hepatitis C virus(HCV)infection among Chinese intravenous drug users(IDUs).METHODS:A total of 432 adult IDUs(95 women and337 men)in Shanghai were included in the study.The third-generation Elecsys Anti-HCV assay(Roche Diagnostics GmbH,Sandhofer Strasse 116,D-68305,Mannheim,Germany)was used to screen for antibodies against HCV.The RIBA strip,a supplemental antiHCV test with high specificity,was performed on all of the samples that tested positive during the initial screening.All of the anti-HCV positive samples were analyzed with a Cobas TaqMan 48 Analyzer(Roche Diagnostics)for direct detection of HCV RNA.All of the HCV RNA-positive samples were sequenced for genotype determination.RESULTS:The preliminary screening identified 262(60.6%)subjects who were seropositive for HCV.Of the 62 females and 200 males seropositive subjects,16(16.7%)and 65(19.3%),respectively,were confirmed by RIBA,yielding an overall HCV seropositive rate of18.8%.Four female(6.5%)and 14 male(7.0%)subjects tested positive for HCV RNA,indicating an active infection rate of 4.2%for the entire study population.The 18 HCV RNA-positive serum samples were genotyped.Seven individuals were genotype 1b,and four were genotype 1a.One individual each was infected with genotypes 2a,2b and 3a.Four subjects were coinfected with multiple strains:two with genotypes 1a and 2a,and two with genotypes 1b and 2a.The active infection rate among HCV-seropositive individuals was22.2%,which was significantly lower than most estimates.CONCLUSION:The prevalence of HCV is relatively low among IDUs in Shanghai,with a spontaneous recovery rate much higher than previous estimates.     

Distribution frequency of hepatitis C virus genotypes in 2231 patients in Iran

Aim: Given the importance of frequency distribution of HCV genotypes, we studied genotypic distribution of HCV in Iran. In this cross-sectional study, 2231 patients with hepatitis C who presented in hepatitis clinics in Tehran were investigated for HCV genotypes. Methods: Genotyping was performed by genotype specific primers. Results: The highest frequency was for genotype 1a, with 886 (39.7%) of subjects. Genotype 3a and 1b were the other frequent genotypes, with 613 (27.5%) and 271 (12.1%) subjects, respectively. Of the samples, 401 (18%) had an undetermined genotype. Mixed genotypes were also found in 33 samples (1.6%). Genotype 1b frequency in patients under 20 years old was 10.2%, while its frequency in patients over 60 years old was 18.5%. Genotype 1b frequency significantly increased by age (P = 0.02). Conclusion: This study indicates that the dominant HCV genotype among patients living in Tehran was 1a.     

Distribution of hepatitis C virus genotypes in patients with chronic hepatitis C infection in Western Turkey.

OBJECTIVE: The primary aim of this study was to determine the recent distribution of various genotypes of hepatitis C virus (HCV) in patients with chronic HCV infection in Western Turkey. Additional objectives were to determine whether there are any associations of genotype with gender and age, and to determine the nucleotide similarities and risk factors of non-1 HCV genotypes. METHODS: Serum samples from 345 patients (176 male, 169 female; mean age 53.3+/-12.7 years, range 10-81 years) with chronic HCV infection were analyzed in this study. Viral genotypes were determined by a restriction fragment length polymorphism (RFLP)-based in-house assay. To confirm genotypes for the samples with band patterns other than genotype 1, the 5' UTR was amplified and sequenced. RESULTS: Genotype 1 was observed in 335 of the 345 patients (97.1%). Of these, 34 patients showed infection with subtype 1a (9.9%) and 301 with subtype 1b (87.2%). Genotypes 2, 3, and 4 were determined in 0.9%, 1.4%, and 0.6% of the patients, respectively. Patients infected with type 1 were significantly older than patients infected with non-1 genotypes; however no significant differences were recorded in gender distribution. CONCLUSIONS: Genotypes other than genotype 1 are quite rare; these are possibly acquired in other countries. Turkish patients with chronic hepatitis C still represent a rather homogenous group with genotypic diversity encountered rarely.     

Molecular epidemiology of hepatitis C infection in U.S. veteran liver transplant recipients: evidence for decreasing relative prevalence of genotype 1B

OBJECTIVE: The U.S. Veteran population represents a unique patient group to study different HCV genotypes because of geographically diverse exposures. The aim of this study was to characterize the distribution of HCV genotypes in U.S. veterans undergoing liver transplantation (OLT), trace genotypes to modes of acquisition (risk behavior and location), and evaluate the relative prevalence of HCV genotypes according to the time of acquisition. METHODS: Between 10/88 and 12/95, 110 primary OLTs were performed in U.S. Veterans at our center. Forty-nine (45%) patients had detectable HCV-RNA by PCR at the time of OLT. Determination of HCV genotypes was performed by restriction fragment length polymorphism of the 5' noncoding region and classified according to Simmonds et al. RESULTS: Twenty-three of 49 (47%) veterans had 1a, 17 (35%) 1b, two (4%) 2a, three (6%) 2b, two (4%) 3a, two (4%) mixed (1a/2a, 1b/2a). This distribution of HCV genotypes was comparable to the genotypic distribution of a contemporary cohort of nonveteran OLT recipients at the University of Washington. There was a statistically significant association between illicit injection drug use (IDU) and 1a, with 63% of 1a patients having IDU whereas only 14% of 1b patients admitted to IDU (p = 0.03). All patients in whom the mode of acquisition was unknown had genotype 1b (p = 0.04). Intranasal cocaine use was strongly correlated with IDU (p = 0.002). Patients who had tattoos but no history of blood transfusion (BT) or recreational drug use had genotype 1 (2 had 1a, 2 had 1b; p = NS). Twenty-two (45%) patients had serological evidence of prior hepatitis B (HBV) infection. Patients who had genotype 2a, 2b, 3a, or mixed were much more likely to have had HBV (seven of nine, 78%) than patients with genotype 1a or 1b (15 of 40, 37.5%) (p = 0.03). There was no significant correlation between BT, dates, or military branch of service, high risk behavior in Southeast Asia, level of education, ethnicity, and particular genotype(s). Whereas the proportion of 1b accounting for HCV infection in patients with a first exposure before 1968 was 50%, all patients with a first exposure post-1975 were non-1b (p = 0.04), suggesting a change in the epidemiology of HCV in our cohort. CONCLUSIONS: In U.S. Veterans undergoing OLT: 1) 45% had PCR-confirmed HCV infection, 2) 1a was the predominant genotype and was associated with IDU, and 3) a significant decrease in the prevalence of genotype 1b from the pre-Vietnam era to post-1975 suggests a changing epidemiology of HCV genotypes.     

云南省大理地区HIV感染者丙型肝炎病毒基因分型研究

目的对大理地区HIV感染合并丙型肝炎患者进行丙型肝炎病毒(HCV)基因分型研究。方法采集患者血液,提取RNA,采用HCV特异性引物进行巢式RT-PCR扩增,PCR产物直接测序,采用生物信息学软件进行序列分析。结果在大理州人民医院共采集疑似丙型肝炎病人血清13份,HCV核酸检测4份(24~27号)阳性。序列分析显示4株病毒之间核苷酸同源性在80.4%~95.8%之间;24号与1b型HCV核苷酸同源性在98.6%以上,而其他基因型病毒核苷酸同源性在90.2%以下;25、27号与3b型HCV核苷酸同源性在92.1%~98.6%之间,而与其他基因型核苷酸同源性均在87.4%以下;26号与3a型HCV核苷酸同源性在94.4%~94.9%之间,而与其他基因型病毒核苷酸同源性在84.6%以下。遗传进化分析显示25、27号病例为3bHCV感染,26号病例为3aHCV感染,24号为1bHCV感染。结论大理地区HIV感染人群中存在HCV基因1和基因3两个基因型,3a、3b和1b3个基因亚型HCV感染。     

The Transmission Route and Selection Pressure in HCV Subtype 3a and 3b Chinese Infections: Evolutionary Kinetics and Selective Force Analysis

Hepatitis C virus (HCV) genotype 3 (GT-3) represents 22–30% of all infections and is the second most common genotype among all HCV genotypes. It has two main subtypes, GT-3a and GT-3b, that present epidemiological differences in transmission groups. This report generated 56 GT-3a and 64 GT-3b whole-genome sequences to conduct an evolutionary kinetics and selective force analysis with reference sequences from various countries. Evolutionary analysis showed that HCV GT-3a worldwide might have been transmitted from the Indian subcontinent to South Asia, Europe, North America and then become endemic in China. In China, GT-3a may have been transmitted by intravenous drug users (IDUs) and become endemic in the general population, while GT-3b may have originated from IDUs and then underwent mutual transmission between blood donors (BDs) and IDUs, ultimately becoming independently endemic in IDUs. Furthermore, the spread of GT-3a and GT-3b sequences from BD and IDU populations exhibit different selective pressures: the proportion of positively selected sites (PPSs) in E1 and E2 from IDUs was higher than in BDs. The number of positive selection sites was higher in GT-3b and IDUs. These results indicate that different selective constraints act along with the GT-3a and GT-3b genomes from IDUs and BDs. In addition, GT-3a and GT-3b have different transmission routes in China, which allows us to formulate specific HCV prevention and control strategies in China.     

Hepatitis C virus: routes of infection and genotypes in a cohort of anti-HCV-positive French blood donors

BACKGROUND: We evaluated and analysed risk factors of HCV-infected blood donors according to HCV genotypes in order to improve the transfusion policy and safety of blood supply. MATERIALS AND METHODS: HCV-RNA was analysed in sera from 518 anti-HCV-positive blood donors, who were invited to medical consultation and interview as to risk factors by means of an extensive questionnaire. HCV genotyping was done on all samples positive for HCV-RNA. RESULTS: Of the 518 sera, 399 (77%) were HCV-RNA positive, and 394 of 399 HCV genotypes were identified. Major genotypes were 1b (34.3%), 3a (24%), 1a (19.5%) and 2 (11.4%). Of the donors, 289 (55.8%) were interviewed regarding their risk behaviour: 27% were former intravenous drug users (IVDUs), 26% had been transfused, 8% had a history of invasive diagnostic procedures, and 13% a history of surgery. Among the 224 interviewed donors, genotypes 1a and 3a were mainly associated with IVDU (51 and 45% respectively) and genotype 1b, with transfusion and nosocomial infections (40 and 25%, respectively). CONCLUSION: In this population of anti-HCV-positive blood donors, nosocomial infection may be a route of HCV spread, but the main risk factor remains IVDU, particularly in young men. The transfusion policy will improve if predonation interviews of such young men are done with a specific and sensitive questionnaire.     

贵州地区HCV感染者基因型分布特征

目的 探讨贵州地区丙型肝炎患者HCV基因型分布特征,为HCV感染的防控和个体化治疗提供临床依据。方法 选取2011年9月-2018年10月贵阳市公共卫生救治中心1211例HCV RNA阳性的丙型肝炎患者,采用PCR直接测序法,与GenBank中已知的HCV序列进行对比,获得HCV基因型及亚型,并分析其分布与性别、年龄、民族、地区、感染途径等因素的关系。计数资料组间比较采用χ2检验或Fisher确切概率法。结果 1211例HCV感染者共检出4种基因型和11种基因亚型,其中以1b型(26.84%)、3b型(27.17%)和6a型(24.28%)为主。不同HCV基因型在男女感染者中分布差异有统计学意义(χ2=15.428,P=0.009),其中男性以3b型为主(29.34%),女性以1b型为主(32.21%)。不同HCV基因型分布在各年龄组中差异有统计学意义(χ2=67.439,P<0.001),≤18岁组与≥60岁组以1b型为主(分别为66.67%、58.93%),而19~39岁组以3b型(28.93%)、6型(29.29%)为主,40~59岁组以1b型(29.54%)、3b型(27.33%)和6型(24.28%)为主。各种感染途径的HCV基因型分布差异有统计学意义(χ2=153.916,P<0.001),感染方式以静脉药瘾为主(57.97%),其次是性接触和有创美容(均为8.42%);经静脉药瘾、有创美容感染HCV者均以3b型为主(分别为31.48%、32.35%),性接触感染者多为HCV 6型(36.27%)。不同民族、贵州地区间HCV基因型分布差异均无统计学意义(P值均>0.05)。结论 贵州地区HCV基因型分布呈多样性,3b、1b、6a型为主要流行株,存在HCV 6型中的多种少见基因亚型,且在不同的年龄、性别、感染途径方面HCV基因型分布存在差异。     

山东地区丙型肝炎病毒的基因型及血清学分型的研究

探索山东地区丙型肝炎病毒(HCV)的基因型及血清学分型的分布,了解HCV基因型与感染途径的关系.对96例抗HCV阳性患者的血清进行HCV RNA检测,HCV RNA阳性者,应用限制性片段长度多态性分析(RELP)进行基因分型;同时应用Murex Serotyping HCV 1-6血清学分型试剂进行血清学分型.基因非2(1b)型79例,占83.16%,2(2a)型为16例占16.84%,44份血清标本的血清学分型可分型率为90.91%,与基因分型的符合率为90.00%.不同的感染途径之间,基因型分布没有差异(P=0.15).山东地区丙型肝炎病毒流行株为基因非2(1b)和2(2a)型,非2(1b)型为优势株,基因分型与血清学分型结果基本一致,基因型与丙型肝炎的感染途径无关.     

Diversity of hepatitis C virus genotypes among intravenous heroin users in Taiwan

IntroductionLimited information is available about genotypes of hepatitis C virus (HCV) in intravenous heroin users in Taiwan. The purpose of this study was to examine the concordance of the detection of antibody to HCV and HCV-RNA and to determine the distribution of HCV genotypes in male intravenous heroin users.MethodsThis was a cross-sectional study. The study population included 274 intravenous heroin drug users newly sentenced in a male prison in central Taiwan from November 2004 to February 2005, whose antibodies to HCV were positive, and antibodies to human immunodeficiency virus were negative. The mean age was 33.9 years (standard deviation, 7.8). The molecular diagnosis used to identify HCV-RNA was PCR.ResultsAmong 274 subjects, 214 subjects were found to contain HCV-RNA. Positive predictive value of HCV infection using antibody to HCV as an indicator was 78.1%. Among 214 subjects, HCV genotype 2a was the most predominant (58.9%, n = 126), followed by 1a (17.3%, n = 37), 1b (14.5%, n = 31), 2b (8.9%, n = 19) and 1a + 2b (0.4%, n = 1). Age-specific analysis also showed genotype 2a was the most prominent genotype among the 4 age groups, with the highest prevalence in groups aged 20 to 29 years and 30 to 39 years (53.3% and 67.6%, respectively).ConclusionsThe concordance of antibody to HCV and HCV-RNA is remarkable in selected high-risk groups. HCV genotype 2a is the most prevalent in male intravenous heroin users in central Taiwan, especially in aged 20 to 29 years and aged 30 to 39 years.     

HCV infection in northeastern Brazil: unexpected high prevalence of genotype 3a and absence of African genotypes.

The genomic diversity of HCV embraces 6 genotypes and at least 52 subtypes with clinical and epidemiological correlations. There is a paucity of studies assessing HCV genotypes and biomolecular epidemiology in Brazil. We studied genotype distribution and epidemiological aspects in 232 HCV carriers, 133 (57.9%) males and 99 (42.1%) females, followed in the liver disease referral unit in Salvador, BA, northeastern Brazil. All of them were anti-HCV positive by 3rd generation ELISA assay, and HCV-RNA positive by RT-PCR. Genotyping was performed by INNOLIPA. Assessment of risk factors for HCV infection showed that 93 (40%) had past blood transfusion, 14 (6%) intravenous drug use, 19 (8%) inhalation of cocaine, 28 (12%) tattooing, 15 (7%) were health care workers, 5 (2%) had reused disposable syringes, 5 (2%) had multiple risk factors and in 53 (23%) no risk factor was determined. Genotype 1a was observed in 75 (32%), 1b in 72 (31%), 3a in 61 (26%), 2ab in 14 (6%); 5 (2.5%) had mixed genotypes and 5 (2.5%) were undetermined. Patients with genotype 1 had a higher mean age (P < 0.05) and no particular risk factors were associated with a specific genotype. Genotype 1 largely predominates in northeast Brazil followed by genotype 3 which, in this population, does not seem to be related to intravenous drug abuse, in contrast to some European studies. Although 80% of the Salvador population comprises African-Brazilians, no African genotype was identified, which may mean that HCV was introduced into this region via European immigration. This study demonstrated some peculiarities of HCV epidemiology in Brazil and strongly suggests that HCV introduction to this region was probably related to European immigration.     

Genotypes and multiple infections with hepatitis C virus in patients with haemophilia A in Japan

SUMMARY. Hepatitis C virus (HCV) RNA was tested for, and HCV genotypes determined, in 96 patients with haemophilia A in Japan. Of 88 patients aged ≥ 10 years, 74 (84%) were positive for HCV RNA at a frequency higher than that in patients aged less than 10 years (one of eight, 13% P <0.001). Genotype I/1a was detected in 30 (40%), II/1b in 12 (16%), III/2a in eight (11%), IV/2b in five (7%) and V/3a in 12 (16%); mixed infection with HCV of two different genotypes was identified in the remaining nine (12%). This distribution was markedly different from that in 767 Japanese HCV carriers without haemophilia, in whom II/1b accounted for the majority (68.7%), I/1a was rare (0.5%), V/3a was absent, and mixed infection was observed rarely (1.3%). Mixed infection was transient in all of the seven haemophilic patients who were followed for 1 to 7 years. One of them was infected with genotype II/ 1b and an unclassifiable genotype, which showed nucleotide sequence similarity to genotype 4c from Zaire (82% homology in the El gene) and to 4a from Egypt (91% homology in a part of the NS5b region). In this patient, HCV of genotype II/1b disappeared while that of group 4 survived during a 4-year observation period. These results indicate different epidemiology of HCV genotypes in Japanese haemophiliacs, attributable to HCV contaminating factor VIII imported in the past, and an increased opportunity in haemophiliacs for mixed infection with HCV of different genotypes.     

Hepatocellular carcinoma in Sweden: its association with viral hepatitis, especially with hepatitis C viral genotypes

Viral markers of chronic hepatitis were tested for in 95 frozen serum samples from 299 patients from Malm?, Sweden, with hepatocellular carcinoma (HCC), diagnosed between 1977 and 1994. Hepatitis B analysis included anti-HBc, HBsAg and, if anti-HBc positive, HBV DNA. Hepatitis C infection analysis included anti-HCV screening, RIBA, HCV RNA and HCV genotyping. HCV genotyping was also carried out in 9 HCV-viraemic HCC-patients from Gothenburg. HCV genotype distribution in HCC cases was compared with Swedish HCV-infected blood donors. Among the 95 patients from Malm?, 28 (29%) had anti-HBc, but only 5 (5%) were chronic HBV carriers, compared with 16 (17%) with chronic hepatitis C (p = 0.021). HCV-related HCC was more common among immigrants (8/16 vs. 8/79; p < 0.001). Genotyping of 25 HCV-infected cases showed genotype 1a in 6 (24%), genotype 1b in 13 (52%), genotype 2b in 4 (16%), and genotype 3a in 2 (8.0%) patients. Genotype 1b was more common among HCC patients than among blood donors (p < 0.001), but 8 of 13 genotype 1b-infected patients were from countries where genotype 1b is predominant. Among native Swedes there was no difference between the HCV genotypes infecting blood donors and those found in HCC patients.