324 Results of a randomized clinical trial of genotype-4 infected subjects when treated with standard or pegylated interferon alfa-2B in combination with ribavirin

et al. 2010

155

118

Hepatitis C virus (HCV) genotypes 4, 5 and 6 represent >20% of all HCV cases worldwide. HCV‐4 is mainly seen in Egypt, where it represents 90% of all HCV cases. Antischistosomal therapy was the main cause of contamination there, followed by procedures performed by informal providers and traditional healers such as dental care, wound treatment, circumcision, deliveries, excision and scarification. It is also highly prevalent in sub‐Saharan Africa and in the Middle East. In Europe, its prevalence has recently increased particularly among intravenous drug users and in immigrants. HCV‐5 is mainly found in South Africa, where it represents 40% of all HCV genotypes, but four pockets of HCV‐5 were found in France, Spain, Syria and Belgium and sporadic cases were found elsewhere. The mode of transmission is mainly iatrogenic and transfusion. HCV‐6 is found in Hong Kong, Vietnam, Thailand and Myanmar and also in American and Australian from Asian origin. The response to treatment in HCV‐4 is intermediate between HCV‐1 and HCV‐2 and HCV‐3. A sustained viral response is achieved in 43–70% with pegylated interferon and ribavirin. It is higher in Egyptians than Europeans and Africans and is negatively related to insulin resistance and to the severity of fibrosis. It increases to >80% with 24 weeks of therapy only if a rapid virological response is achieved. In HCV‐5, a sustained virological response is achieved in >60% with 48 weeks of therapy. HCV‐6 is also considered an easy‐to‐treat genotype, leading to a response in 60–85% of cases.

Section: Treatmentmentioning

confidence: 61%

The neglected hepatitis C virus genotypes 4, 5 and 6: an international consensus report

Antaki

Craxı̀

et al. 2010

155

118

“…The treatment of chronic HCV‐G4 with an IFN‐based regimen has advanced steadily. (25, 28–39) Initial clinical trials showed low sustained virological response (SVR) rates similar to those achieved in HCV‐G1 patients. Studies found that IFN‐α monotherapy, which is usually administered at a dose of 3–5 MIU three times a week, resulted in an SVR in only 5–25% of treated patients (12, 28–30).…”

Section: Chronic Hepatitis C Genotype 4 Treatment (Table 1)mentioning

confidence: 99%

Hepatitis C genotype 4 therapy: increasing options and improving outcomes

2009

Hepatitis C virus genotype 4 (HCV-G4) is prevalent in the Middle East and Africa and has spread to several regions in Europe. HCV-G4 represents a major health problem in Egypt, with a prevalence rate of 13%. Recently, HCV-G4 has been spreading in Europe particularly among intravenous drug users (IDU) populations, who represent the main reservoir for HCV in Europe. This article reviews the current therapeutic strategies for HCV-G4 infections in different populations. HCV-G4 has been considered a difficult-to-treat genotype because of the poor sustained virological response (SVR) rates reported with a conventional interferon (IFN)-based regimen. Pegylated IFN and ribavirin combination therapy was associated with significant improvements in SVR rates that currently exceed 60%, particularly with individualized therapy. Lower response rates have been reported in specific situations, namely chronic HCV-G4 infection in IDUs and patients coinfected with human immunodeficiency virus (HIV). Rapid and early virological responses have been useful tools for determination of the duration of therapy. In conclusion: therapy of HCV-G4 has shown significant improvements, with higher sustained response rates and possibilities for a shorter duration. More research is required to optimize therapy in special populations such as IDUs and HIV-co-infected patients.

“…A steady improvement in the overall response rates of chronic HCV‐4 hepatitis to C therapy was achieved with the introduction of pegylated interferon (PEG‐IFN)‐α2, which resulted in a dramatic improvement in SVR rates compared with conventional IFN‐α (34–44) (Fig. 1).…”

Section: Treatment Of Chronic Hepatitis C Virus Genotype 4‐naïve Patimentioning

confidence: 99%

“…A meta‐analysis of studies conducted until 2003 that included genotype 4 patients showed significantly higher SVR rates among genotype 4 patients receiving PEG‐IFN‐α plus ribavirin than in those receiving conventional IFN‐α plus ribavirin (55 vs. 30%, P =0.0088) (38). Controlled randomized and non‐randomized clinical trials demonstrated high SVR rates ranging between 50 and 79% in chronic HCV‐4 hepatitis patients receiving PEG‐IFN‐α2b plus ribavirin (34–46) (Fig. 2).…”

Section: Treatment Of Chronic Hepatitis C Virus Genotype 4‐naïve Patimentioning

confidence: 99%

Hepatitis C virus genotype 4 therapy: progress and challenges

2011

The hepatitis C virus genotype 4 (HCV‐4) is prevalent in Egypt, the Middle East and Africa. Recently, the epidemiology of HCV‐4 has changed and this genotype has begun to cross borders and spread to several regions in Europe through immigration and injection drug use. HCV‐4 has been considered a difficult‐to‐treat genotype based on the low sustained virological response (SVR) rates obtained with conventional interferon (IFN)‐based regimens. Pegylated interferons (PEG‐IFN) plus ribavirin therapy for chronic HCV‐4 has been associated with increased SVR rates of more than 60%. Shorter treatment of chronic HCV‐4 patients with rapid and early virological responses has been associated with high SVR rates, better compliance, fewer adverse events and lower costs. Despite this progress, the treatment of HCV‐4 non‐responders, injection drug users, patients coinfected with human immunodeficiency virus, thalassaemic patients, patients on haemodialysis and patients with HCV‐4 recurrence after liver transplantation still represents a significant therapeutic challenge. Treatment of HCV‐4 has markedly improved, with higher sustained response rates and the possibility of shorter regimens. Despite the recent progress in the treatment of HCV‐4, more research is required to optimize current therapy and include genotype 4 patients in clinical trials on emerging therapies such as specifically targeted antiviral therapy for HCV with protease and/or polymerase inhibitors.