Management of hepatitis C virus genotype 4: Recommendations of An International Expert Panel

Abstract

HCV has been classified into no fewer than six major genotypes and a series of subtypes. Each HCV genotype is unique with respect to its nucleotide sequence, geographic distribution, and response to therapy. Genotypes 1, 2, and 3 are common throughout North America and Europe. HCV genotype 4 (HCV-4) is common in the Middle East and in Africa, where it is responsible for more than 80% of HCV infections. It has recently spread to several European countries. HCV-4 is considered a major cause of chronic hepatitis, cirrhosis, hepatocellular carcinoma, and liver transplantation in these regions. Although HCV-4 is the cause of approximately 20% of the 170 million cases of chronic hepatitis C in the world, it has not been the subject of widespread research. Therefore, this document, drafted by a panel of international experts, aimed to review current knowledge on the epidemiology, natural history, clinical, histological features, and treatment of HCV-4 infections.

Sofosbuvir plus Ribavirin for Treatment-Naïve Chronic HCV Genotype 4 Patients: Real-life Experience

“…The most common adverse events in both groups were anemia, headache, epigastric pain, insomnia, and heart burn, table (4). Although most adverse effects were more common in patients treated for 24 weeks, this does not appear to be explained simply by longer duration, since the differences between the groups were recorded during the first 12 weeks of treatment.…”

“…Until recently, therapy for genotype 4 HCV has been pegylated interferon (PegIFNá) with ribavirin (RBV) for 24 to 48 weeks, depending on virologic response. Treatment-naïve patients receiving this regimen have sustained virologic response (SVR) rates of 43% to 70% [4]. As a result of difficulty in administration and poor tolerability associated with PegIFNá and RBV, treatment uptake has been low, and most patients with HCV in Egypt are untreated [5].…”

Genotype 4 Hepatitis C Virus Responds Worse than Genotype 1 to 48-Week Combination Treatment with Pegylated Interferon Alpha Plus Ribavirin: a Greek Multi-Centered Study

“…Hepatitis C virus (HCV) is classified into six major genotypes and a series of subtypes, according to its nucleotide sequence [1,2]. Prevalence rates are attributable to the geographical distribution of genotypes, with genotype 4 predominating in Middle East and Africa [1][2][3][4].…”

“…Prevalence rates are attributable to the geographical distribution of genotypes, with genotype 4 predominating in Middle East and Africa [1][2][3][4]. Recent epidemiological studies report of an increasing prevalence of genotype 4 in western countries, mainly due to imported viral infection from endemic areas [5][6][7].…”

Phylogenetic Analysis of Isolated HCV Strains from Tunisian Hemodialysis Patients

“…Genotypes 1, 2, and 3 are distributed almost worldwide (25). Genotype 4 has been reported to be the most prevalent genotype in northern and central Africa, Middle East, and Egypt (7,19,37). Genotype 5 was found in South Africa and genotype 6 was especially located in South East Asia (32).…”