Genotype Distribution and Noninvasive Fibrosis Assessment in Chronic HCV - Insights from a Tertiary Center in Eastern India

IntroductionHepatitis C virus (HCV) genotype distribution and fibrosis burden vary geographically and influence clinical management. Genotype 3 predominates in India and neighboring regions and is associated with steatosis and faster fibrosis progression. This study aims to characterize HCV genotypes, liver stiffness (FibroScan), and the comparative performance of non-invasive fibrosis markers (APRI, FIB-4) in patients from AIIMS Kalyani, West Bengal. MethodsBetween March 2023 and March 2025, a total of 1,105,120 patients attended the outpatient department and 33,287 were admitted to inpatient care at AIIMS Kalyani. Among them, 29,169 individuals were screened for anti-HCV antibodies. HCV seropositivity was detected in 140 patients (0.48%). Among these, 120 underwent HCV RNA PCR testing, of which 32 were confirmed RNA-positive and were enrolled for further evaluation in the Viral Hepatitis Treatment Clinic. Twenty seropositive patients were lost to follow-up. Detailed clinical, laboratory, and liver fibrosis assessments (FibroScan, APRI, FIB-4) were conducted in these 32 patients. ResultsAmong 32 HCV RNA-positive patients, the mean age was 42.1 years, with 22 males (68.8%). Genotype 3 was predominant (43.8%), followed by genotype 1 (25%). Cirrhosis was detected in 15.6% (5/32) by FibroScan. FIB-4 >3.25 showed 80% sensitivity and 95.5% specificity (AUROC 0.96) for detecting cirrhosis, outperforming APRI >1.5, which had 40% sensitivity and 90.9% specificity (AUROC 0.840). These results support the FIB-4 as a reliable, low-cost alternative to FibroScan for assessing fibrosis in low-resource settings. ConclusionFrom a large population screened over two years, only a small fraction demonstrated active HCV infection requiring treatment. Genotype 3 remains the most prevalent in Eastern India, associated with steatosis and progressive fibrosis. FIB-4 provides superior non-invasive prediction of cirrhosis compared to APRI, supporting its use in resource-limited settings.