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

Abstract

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.

Impact of the IL-18 gene polymorphism in response to antiviral therapy in chronic HCV genotype 4 patients

“…The main cause of chronic HCV in the Middle East and Egypt is HCV genotype 4 (HCV-4). Recently, HCV infection has been reported in southern Europe among immigrants, mostly from Africa, and among intravenous drug users 1,2 .…”

New treatments for chronic hepatitis C infection

“…However, Peg-IFN and Ribavirin therapy resulted in SVR in 45% of genotype 1 patients [1][2][3] and low tolerability of IFNbased treatments further decreased the hope for cure in this group of patients. Higher SVR rates were achieved in patients with HCV genotypes 2,3 and 5, and intermediate SVR rates were achieved in HCV genotype 4 infection [10].…”

Safety and Efficacy of Pegylated Interferon alpha-2a and Ribavirin Combination in Treatment of Egyptian Patients with Chronic Hepatitis C Genotype-4

“…Much of this transmission occurs through iatrogenic and interfamilial routes of transmission [15,16]. Nevertheless, a significant proportion of CHC Egyptian patients have an unknown source of infection indicating the possibility of undiscovered modes of transmission [17]. That is why treatment is considered a corner stone in the control of hepatitis C epidemic in Egypt.…”