Evolutionary genetics of HCV: from population to patient
SPEAKER: Jeffrey B. Joy, PhD
BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
Department of Medicine, University of British Columbia, Vancouver, BC, Canada
Hepatitis C virus (HCV) represents a health crisis of global proportions with an estimated 185 million infected persons worldwide including approximately 4.6 million infections of predominantly HCV genotype 1a within North America. Despite the advent of curative HCV therapies many challenges remain at all levels of the epidemic hierarchy. One such challenge concerns resolving the controversy surrounding the timing of the initial spread of hepatitis C genotype 1a in North America. In particular, how and when HCV reached extraordinary prevalence in specific demographic groups has remained unclear. Secondly, natural HCV polymorphisms conferring resistance to direct acting antiviral therapy exist however the frequency of these variants at the population level is uncertain. A third problem facing treatment of HCV particularly in high risk populations is that identification and treatment of individuals with mixed HCV infections (infection with 2 or more distinct viral variants) is challenging and the detection of such mixed infections remains complex. Finally, HCV therapy rapidly leads to undetectable viral load, and consequently the loss of any ability to closely monitor what is happening to the virus in vivo until a patient relapses or achieves sustained virological response. In this talk I will apply evolutionary genetic methods to the abundance of available sequence data at the both the population level and longitudinally within individual patients to contribute to resolving these controversies and problems and provide practical insights into HCV epidemic dynamics at multiple scales.