Predictors of sustained virological response in Greek and Egyptian patients with hepatitis C genotype 4: Does ethnicity matter?

Abstract

Hepatitis C virus genotype 4 (HCV-4) is spreading beyond Africa and the Middle East but data regarding treatment with pegylated interferon alpha and ribavirin of European populations infected with HCV-4 remains limited. Interestingly, European (vs. Egyptian) origin has been associated with lower sustained virological response rates. Hence the aim of this study was to investigate the treatment outcomes of Greek (vs. Egyptian), treatment-naïve patients infected with HCV-4 (subtype a) and to identify factors influencing response rates. One hundred seventy-seven consecutive patients (mean age: 44.6 ± 10.2, males: 143/177; 80.8%, Egyptians: 76/177; 42.9%) treated over a 7-year period at the Hepatology clinics of three tertiary care hospitals in Greece were retrospectively evaluated. Overall, sustained virological response was achieved in 75/177 (42.4%) of the cohort without a significant difference between the two ethnic groups [Greek: 44/101 (43.6%); Egyptian 31/76 (40.8%), P = 0.7598]. In multivariate analysis, it was found that ethnicity was not associated with an impaired response but age ≥45 years [odds ratio (OR): 0.4225, 95% confidence interval (CI): 0.2135-0.8133; P = 0.0134], diabetes (OR: 0.2346, 95% CI: 0.0816-0.0674; P = 0.0071), advanced liver fibrosis (OR: 0.3964, 95% CI: 0.1933-0.8133; P = 0.0116), and treatment suspension (OR: 0.1738, 95% CI: 0.0482-0.6262; P = 0.0075) showed an independent negative association with response to antiviral treatment. In contrast to previous European data suggesting Egyptian ethnicity to be a positive predictor for a sustained virological response, there was no influence of Greek versus Egyptian ethnicity on treatment outcomes. Higher age, advanced liver fibrosis, and diabetes have been shown to reduce significantly response rates in patients infected with HCV-4.

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

“…In Greece, prevalence of genotype 4 is amongst the highest reported within Europe, estimated around 15% [18][19][20][21][22]. Similarly, a percentage of 14.7% was confirmed in our study cohort of consecutive HCV patients.…”

“…In Greece, genotype 4 accounts for about 15% of all HCV infections [18][19][20][21][22] and is generally considered as "difficult to treat" in everyday clinical practice.…”

The predictive value of IL28B rs12979860, rs11881222 and rs8099917 polymorphisms and IP-10 in the therapeutic response of Egyptian genotype 4 patients

“…The polymorphism rs12979860 had the highest predictive value of SVR compared with rs11881222 and rs8099917, and the CC genotype of rs12979860 had the highest predictive value in genotype 4. Moreover, the multivariate regression analysis showed that the rs12979860 SNP was the only SNP associated with clearance, whereas the other SNPs ceased, confirming that this association was based on a single signal (Papastergiou et al, 2012).…”

“…Higher age, advanced liver fibrosis, and diabetes have been shown to significantly reduce the response rates in patients infected with HCV-4, and Egyptian ethnicity has been claimed to be a positive predictor of a sustained virological response (Papastergiou et al, 2012) that is not related to insulin resistance (Cieśla et al, 2012). Serum adiponectin at baseline levels appears to be an independent predictor in the achievement of SVR in Genotype 4 (Derbala et al, 2009).…”

Meta-analysis

“…The majority of studies (40/51, 78%) originated from the Middle East[10–13, 15, 16, 18, 27, 28, 34, 35, 37, 40–42, 45, 46, 53–56, 59, 62, 63, 66, 67, 69, 72, 75, 78, 80, 81, 83–85, 88, 91, 95] and Europe (9/51, 18%)[14, 38, 39, 65, 71, 76, 79, 93, 96]. One originated in Cameroon[77] and one multi-center study was conducted in 19 countries[73].…”