INTRODUCTION 🧬
Hepatitis C virus (HCV) continues to pose a substantial public health burden in Thailand, especially due to the variability in genotype distribution across different regions. Although the advent of pan-genotypic direct-acting antivirals (DAAs) has revolutionized treatment, the role of genotype-specific surveillance remains critical in national strategies aiming for HCV elimination. The molecular diversity of HCV not only influences therapeutic outcomes but also affects viral load dynamics and epidemiological patterns. This study investigates the genotype distribution among 1,737 HCV-infected individuals in northern Thailand over an eight-year period, leveraging Sanger sequencing and reverse hybridization line probe assays (LiPA) for accurate genotyping. With genotype 3 emerging as the most prevalent, closely followed by genotypes 1 and 6, the research offers timely insights into viral evolution and demographic associations. Importantly, the observed rise in genotype 6 prevalence in recent years signals the need for targeted interventions and real-time surveillance. These findings contribute vital molecular data to inform public health strategies, especially as Thailand accelerates efforts toward the World Health Organization’s goal of HCV elimination by 2030.
GENOTYPE DISTRIBUTION AND EPIDEMIOLOGICAL SHIFTS 🔬
This study highlights the changing molecular landscape of HCV genotypes in northern Thailand, with genotype 3 (36.6%) being the most prevalent, followed closely by genotype 1 (35.8%) and genotype 6 (27.2%). Notably, the predominance of subtype 3a and the notable representation of 1a and 6 subtypes illustrate the dynamic viral diversity in this region. The emergence of genotype 6 as a growing fraction of the HCV burden, particularly after 2021, underscores epidemiological shifts that require strategic attention. Regional factors, behavioral risk patterns, and possible migration dynamics may be influencing these genotype changes. Longitudinal genotype monitoring offers a robust tool for mapping viral trends and anticipating treatment demands.
DEMOGRAPHIC TRENDS IN GENOTYPE PREVALENCE 👥
Analysis by sex reveals noteworthy genotype patterns: males were more frequently infected with genotype 1, while females had a higher prevalence of genotype 3. These differences may reflect varying exposure risks, healthcare access, or biological susceptibilities. Understanding gender-based trends is vital for customizing public health messaging and therapeutic approaches. Moreover, age and social determinants may intersect with viral genotypes, warranting broader epidemiological research to support gender- and age-sensitive HCV care policies in Thailand and similar endemic regions.
VIRAL LOAD DIFFERENCES ACROSS GENOTYPES 📊
A significant finding of the study is that genotype 6 infections are associated with markedly higher median viral loads compared to genotypes 1 and 3 (p < 0.0001). Elevated viral loads can correlate with increased transmission potential and disease severity, impacting treatment planning and public health responses. The high viral replication rates in genotype 6 suggest possible differences in viral fitness or host-pathogen interactions. This highlights the need to evaluate the efficacy of DAAs against genotype 6 in clinical settings, potentially guiding the optimization of dosage and duration.
GENOTYPING METHODS: SANGER VS. LIPA 🧪
The dual-method approach employed—Sanger sequencing and reverse hybridization line probe assay (LiPA)—provides robustness to the genotyping data. Each technique offers specific advantages: Sanger sequencing allows for detailed nucleotide-level resolution, while LiPA enables rapid subtype differentiation. By combining these methods, the study ensures high accuracy and reliability in genotype assignments, especially important when detecting diverse and rare subtypes within genotype 6. This methodological strength also supports the reproducibility of findings and sets a high standard for regional HCV surveillance studies.
IMPLICATIONS FOR THAILAND’S HCV ELIMINATION STRATEGY 🎯
The evolving genotype landscape, especially the rise of genotype 6, has direct implications for Thailand’s efforts to eliminate HCV by 2030. Although pan-genotypic DAAs are available, genotype-specific surveillance can guide public health priorities, including screening strategies, treatment rollouts, and resource allocation. This study provides a foundational dataset that policymakers and clinicians can leverage to tailor interventions more effectively. Continued molecular surveillance, integrated with real-time epidemiological data, will be essential to achieving sustainable elimination and minimizing the clinical burden of HCV in Thailand.
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