Genotyping and treatment issues with 'unusual' HCV 1 subtypes.

Unusual non 1a/1b HCV 1 subtypes are mostly prevalent in Sub-Saharan Africa. These variants harbour resistance associated substitutions as natural polymorphisms in the NS5A region and are difficult to characterize and treat. We report the HCV genome sequences from two African subjects with unusual subtype 1 g and 1e treated with the pangenotypic regimen sofosbuvir/velpatasvir with failure in the latter. Sequence analysis of different regions of the HCV genome in a subtype 1 reference panel and use of multiple subtyping tools showed that the NS5A region is the most suitable to detect these unusual HCV subtypes and assist treatment choices.