{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:55:20Z","timestamp":1760147720882,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T00:00:00Z","timestamp":1677369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Megaprojects of China for Infectious Diseases","award":["2017ZX10103009"],"award-info":[{"award-number":["2017ZX10103009"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Acute-on-chronic liver failure (ACLF) is defined as a syndrome of acutely decompensated cirrhosis in patients with chronic liver disease (CLD). Here we report an ACLF case caused by a flare of occult hepatitis C infection. This patient was infected with hepatitis C virus (HCV) more than a decade ago and hospitalized due to alcohol-associated CLD. Upon admission, the HCV RNA in the serum was negative and the anti-HCV antibody was positive, whereas the viral RNA in the plasma dramatically increased during hospitalization, which suggests an occult hepatitis C infection. Overlapped fragments encompassing the nearly whole HCV viral genome were amplified, cloned, and sequenced. Phylogenetic analysis indicated an HCV genotype 3b strain. Sanger sequencing to 10-fold coverage of the 9.4-kb nearly whole genome reveals high diversity of viral quasispecies, an indicator of chronic infection. Inherent resistance-associated substitutions (RASs) in the NS3 and NS5A but not in the NS5B regions were identified. The patient developed liver failure and accepted liver transplantation, followed by direct-acting antiviral (DAA) treatment. The hepatitis C was cured by the DAA treatment despite the existence of RASs. Thus, care should be taken for occult hepatitis C in patients with alcoholic cirrhosis. The analysis of viral genetic diversity may help to identify an occult hepatitis C virus infection and predict the efficacy of anti-viral treatment.<\/jats:p>","DOI":"10.3390\/v15030634","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T04:05:40Z","timestamp":1677470740000},"page":"634","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High-Resolution Genomic Profiling of a Genotype 3b Hepatitis C Virus from a Flare of an Occult Hepatitis Patient with Acute-on-Chronic Liver Failure"],"prefix":"10.3390","volume":"15","author":[{"given":"Xue","family":"Mei","sequence":"first","affiliation":[{"name":"Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingyi","family":"Zou","sequence":"additional","affiliation":[{"name":"Key Laboratory of Medical Molecular Virology (MOE\/NHC\/CAMS), School of Basic Medical Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bisheng","family":"Shi","sequence":"additional","affiliation":[{"name":"Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiping","family":"Qian","sequence":"additional","affiliation":[{"name":"Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhigang","family":"Yi","sequence":"additional","affiliation":[{"name":"Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China"},{"name":"Key Laboratory of Medical Molecular Virology (MOE\/NHC\/CAMS), School of Basic Medical Sciences, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"17006","DOI":"10.1038\/nrdp.2017.6","article-title":"Hepatitis C virus infection","volume":"3","author":"Manns","year":"2017","journal-title":"Nat. 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