Suppose virus A has a viral genome of 19,000 bp, and 10,000,000,000 viruses are

Question

Suppose virus A has a viral genome of 19,000 bp, and 10,000,000,000 viruses are replicated in an infected individual in a single day. Assume that a single mutation at a particular location in the virus A genome is needed for virus A to develop antiviral drug resistance to ledipasvir. The mutation can be a transition or transversion mutation. If RNA polymerase introduces an error in 1 of every 10,000 bases synthesized, how long will it take for virus A to overcome ledipasvir therapy and develop resistance? Round your answer up to a whole number of days.

Explanation / Answer

Hepatitis C virus (HCV) can cause both acute and chronic hepatitis. The acute process is self-limited, rarely causes hepatic failure, and usually leads to chronic infection. Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation. (See "Clinical manifestations and natural history of chronic hepatitis C virus infection".)

The goal of treatment is to eradicate HCV RNA, which is predicted by the achievement of a sustained virologic response (SVR), defined by the absence of HCV RNA by polymerase chain reaction three to six months after stopping treatment. An SVR is associated with a 99 percent chance of being HCV RNA negative during long-term follow-up and can therefore be considered cure of the HCV infection [1]. Achievement of an SVR has also been associated with improved clinical outcomes.

This topic will review the treatment of patients with chronic genotype 1 HCV infection. Treatment of patients with other genotypes, experimental agents for the treatment of HCV, the treatment of acute HCV, the selection of patients for treatment, the management of treatment-induced side effects, and factors that predict a response to treatment are discussed elsewhere:

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