{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T21:17:07Z","timestamp":1768511827864,"version":"3.49.0"},"reference-count":8,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,2,2]],"date-time":"2021-02-02T00:00:00Z","timestamp":1612224000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In sub\u2010Saharan Africa, there exist distinct HCV genotype (GT) subtypes harbouring resistance\u2010associated substitutions to commonly used non\u2010structural protein 5A (NS5A) inhibitor\u2013based direct\u2010acting antiviral (DAA) regimens. In particular, GT4r subtype has demonstrated high rates of treatment failure. In the absence of routine viral sequencing in sub\u2010Saharan Africa, it is important to identify sociodemographic, epidemiologic, and clinical characteristics that may be associated with GT4r infection. Methods: A secondary analysis was performed on data from 300 adults with HCV GT4 enrolled in a prospective trial assessing the safety and efficacy of sofosbuvir\u2010ledipasvir in Rwanda in 2017. The association between characteristics at enrolment and GT subtype was assessed by chi\u2010square analysis and logistic regression. In multivariate analysis, there were a higher proportion of participants with GT4r subtype with age &lt;40\u00a0years (OR: 3.6, 95% CI: 1.3\u201310.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.02), previous hospitalization (OR: 2.5, 95% CI: 1.3\u20135.0, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.006), previous surgery (OR: 2.2, 95% CI: 1.1\u20134.2, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.03), cirrhosis (OR: 3.2, 95% CI: 1.3\u20137.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.008) and baseline HCV RNA &gt;1 million IU\/ml (OR: 3.4, 95% CI: 1.6\u20136.9, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.001). Rwandan adults with GT4r are more likely to be younger, have a history of hospital admissions and surgeries and have more active or advanced liver disease compared to those with other GT4 subtypes. In the absence of advanced diagnostics to assess GT subtype, patients with these characteristics may warrant closer monitoring for treatment failure or alternative DAA regimens. More treatment experience with diverse DAA regimens is urgently needed for GT subtypes particular to this region.<\/jats:p>","DOI":"10.1111\/jvh.13467","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T01:29:24Z","timestamp":1610674164000},"page":"682-686","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk factors for difficult\u2010to\u2010treat hepatitis C virus genotype 4r in Rwanda and implications for elimination in sub\u2010Saharan Africa"],"prefix":"10.1111","volume":"28","author":[{"given":"Fabienne","family":"Shumbusho","sequence":"first","affiliation":[{"name":"Partners In Health\/Inshuti Mu Buzima Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3275-5347","authenticated-orcid":false,"given":"Anne F.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Gastroenterology and Endoscopy Brigham and Women\u2019s Hospital and Harvard Medical School Boston USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrick","family":"Kateera","sequence":"additional","affiliation":[{"name":"Partners In Health\/Inshuti Mu Buzima Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jules","family":"Kabahizi","sequence":"additional","affiliation":[{"name":"Rwanda Military Hospital Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabin","family":"Nsanzaimana","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janvier","family":"Serumondo","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9275-8844","authenticated-orcid":false,"given":"Jean","family":"Damascene Makuza","sequence":"additional","affiliation":[{"name":"Rwanda Biomedical Center Kigali Rwanda"},{"name":"School of Population and Public Health University of British Columbia Vancouver Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip M.","family":"Grant","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Stanford University Palo Alto USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Musabeyezu","sequence":"additional","affiliation":[{"name":"King Faisal Hospital Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claude","family":"Muvunyi","sequence":"additional","affiliation":[{"name":"College of Medicine and Health Sciences University of Rwanda Kigali Rwanda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3470-5351","authenticated-orcid":false,"given":"Neil","family":"Gupta","sequence":"additional","affiliation":[{"name":"Partners In Health Boston USA"},{"name":"Division of Global Health Equity Brigham &amp; Women\u2019s Hospital Boston USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,2,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(16)30181-9"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(18)30382-0"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.07.025"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13322"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30225"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.08.018"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-019-4322-7"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2020.05.029"}],"container-title":["Journal of Viral Hepatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.13467","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jvh.13467","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.13467","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T22:15:43Z","timestamp":1693692943000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jvh.13467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,2]]},"references-count":8,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["10.1111\/jvh.13467"],"URL":"https:\/\/doi.org\/10.1111\/jvh.13467","archive":["Portico"],"relation":{},"ISSN":["1352-0504","1365-2893"],"issn-type":[{"value":"1352-0504","type":"print"},{"value":"1365-2893","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,2]]},"assertion":[{"value":"2020-11-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}