Clinical and Pathological Characteristics and Response to Combination Therapy of Genotype 4 Chronic Hepatitis C Patients: Experience from a Spanish Center

Trapero-Marugán, María; Moreno-Monteagudo, J.A.; Garcı́a-Buey, Luisa; Borque, M.J.; Medina, Jesús; Garcı́a-Sánchez, Asunción; Moreno–Otero, Ricardo

doi:10.1179/joc.2007.19.4.423

Cited by 17 publications

(17 citation statements)

References 23 publications

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“…Another study (46) showed that treatment of patients with chronic HCV‐G4 by PEG‐IFN α‐2b and ribavirin induces a more rapid decrease in the HCV RNA level and a better SVR rate (62 vs. 13%) in Egyptians than in non‐Egyptians. In contrast, a Spanish study (47) evaluating the response of chronic HCV‐G4 treatment‐naive Spanish patients to combination therapy revealed a sustained virological response of 55%. Patients infected with HCV‐G4 showed a lower stage of fibrosis, lower viraemia and a higher SVR rate compared with genotype 1.…”

Section: Do All Patients With Chronic Hepatitis C Genotype 4 Achieve mentioning

confidence: 86%

Hepatitis C genotype 4 therapy: increasing options and improving outcomes

Kamal

2009

Liver International

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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.

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Section: Do All Patients With Chronic Hepatitis C Genotype 4 Achieve mentioning

confidence: 86%

Hepatitis C genotype 4 therapy: increasing options and improving outcomes

Kamal

2009

Liver International

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“…Another study (53) showed that treatment of patients with chronic HCV‐4 infection by PEG‐IFN‐α2b and ribavirin results in a more rapid decrease in HCV RNA level and a better SVR rate (62 vs. 13%) in Egyptians than in non‐Egyptians. In contrast, a Spanish study (54) evaluating the response of chronic HCV‐4 treatment‐naïve Spanish patients to combination therapy revealed a SVR of 55%. Patients infected with HCV‐4 had a lower stage of fibrosis, lower viraemia and a higher SVR rate compared with those with genotype 1.…”

Section: Pharmacogenetics Race Ethnicity and Personalized Medicine mentioning

confidence: 86%

Hepatitis C virus genotype 4 therapy: progress and challenges

Kamal

2011

Liver International

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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.

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“…Finally, the response to antiviral therapy may also differ significantly in this heterogeneous genotype. For instance, patients from Egypt and the Middle East showed significantly higher sustained virological response (SVR) rates when treated with peginterferon and ribavirin,14 15 compared to European patients treated with the same regimen 16 17. Again, the influence of insulin resistance shown to be a major predictor of SVR in other genotypes,18 19 20 21 is not determined in patients with HCV-4.…”

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confidence: 99%