Rare detection of Hepatitis C virus genotype 4 in a patient with pulmonary tuberculosis: First report from central India.

Hepatitis C virus (HCV) genotype 4 (GT4) is exceptionally rare in central India. We report the first molecularly confirmed case of HCV GT4a in a 26-year-old severely malnourished male (body weight 39 kg) presenting with active pulmonary tuberculosis (TB) in Madhya Pradesh. Following the detection of active viremia (1.1 × 105 IU/mL), Sanger sequencing of the Core region and nucleotide homology analysis definitively confirmed genotype 4a. Despite compounding hepatotoxic risks from severe cachexia and viral co-infection, no hyperacute or immediate acute hepatic injury was observed during the initial 6-day inpatient stabilization phase of standard first-line anti-tubercular therapy, with transaminases remaining strictly within normal limits.